Insurance Name,Plan Name,Bill Code Type,Bill Code,Bill Code Description,Alternante Bill Code Type,Alternate Bill Code,Alternate Bill Code Description,NDC,List Price,Inpatient Discount Charge,Outpatient Discount Charge,Plan Price,Medication Pack Size,Medication Pack UOM,Comments
Beacon Health,Commercial and Medicaid Only,HCPC's,90832,Individual Psychotherapy 30 Mi,,,,, $250.16 , $-   , $-   , $200.00 ,,,Pro Fees not included
Beacon Health,Commercial and Medicaid Only,HCPC's,90834,Individual Psychotherapy 45-5,,,,, $501.38 , $-   , $-   , $200.00 ,,,Pro Fees not included
Beacon Health,Commercial and Medicaid Only,HCPC's,90853,Group Psychotherapy,,,,, $326.00 , $-   , $-   , $200.00 ,,,Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,,Private Room,,,,," $1,083.00 ", $-   , $-   ," $1,250.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,,Semi-Private Room,,,,," $1,051.00 ", $-   , $-   ," $1,250.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,,ICU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,250.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,,CCU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,250.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ", $-   , $-   ," $1,237.00 ",,,Not included in contract
Magic Vendor,Ms State Dept of Correciton,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ", $-   , $-   ," $1,423.00 ",,,Not included in contract
Magic Vendor,Ms State Dept of Correciton,HCPC's,90832,Individual Psychotherapy 30 Mi,,,,, $250.16 , $-   , $-   , $250.16 ,,,Not included in contract
Magic Vendor,Ms State Dept of Correciton,HCPC's,90834,Individual Psychotherapy 45-5,,,,, $501.38 , $-   , $-   , $501.38 ,,,Not included in contract
Magic Vendor,Ms State Dept of Correciton,HCPC's,90853,Group Psychotherapy,,,,, $326.00 , $-   , $-   , $326.00 ,,,Not included in contract
Magic Vendor,Ms State Dept of Correciton,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ", $-   , $-   ," $102,500.00 ",,,Dailey Per Diem Avg LOS 82 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ", $-   , $-   ," $20,000.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ", $-   , $-   ," $27,500.00 ",,,Dailey Per Diem Avg LOS 22 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ", $-   , $-   ," $33,750.00 ",,,Dailey Per Diem Avg LOS 27 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ", $-   , $-   ," $38,750.00 ",,,Dailey Per Diem Avg LOS 31 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ", $-   , $-   ," $20,000.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ", $-   , $-   ," $37,500.00 ",,,Dailey Per Diem Avg LOS 30 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ", $-   , $-   ," $43,750.00 ",,,Dailey Per Diem Avg LOS 35 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ", $-   , $-   ," $52,500.00 ",,,Dailey Per Diem Avg LOS 42 days Pro Fees not included
Magic Vendor,Ms State Dept of Correciton,DRG,884,Organic Disturbances & Mental Retardation,,,,," $20,776.82 ", $-   , $-   ," $20,776.82 ",,,Not included in contract
Magic Vendor,Ms State Dept of Correciton,DRG,885,Psychoses,,,,," $22,724.68 ", $-   , $-   ," $22,724.68 ",,,Not included in contract
Magic Vendor,Ms State Dept of Correciton,DRG,,Interrupted Stay,,,,, $-   , $-   , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Code Blue,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peg Tube Placement,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perfusion 1 Hour,,,,, $369.94 , $369.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Picc Line Insertion,,,,," $2,855.64 "," $2,855.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debride Skin Full,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debride Skin Partial,,,,, $351.92 , $351.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 , $652.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 , $620.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 "," $1,240.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulsed Lavage,,,,, $184.44 , $184.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wound Care,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitiamin D 600 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,0.9% 10ml Flush,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,1eppra 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,250ml Bolus Ns,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,A&d Ointment,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 "," $3,051.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 "," $3,244.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abreva Cream 2gm,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accuzyme Oint 30gm,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acebutolol 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen 500,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen 650mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen/Codeine,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetazolamide 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetazolamide 500mg,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acyclovir 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acyclovir 500mg Inj,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acyclovir Oint 5gm,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acyclovir Susp 200mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adenosine  6mg Syri,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aggrenox 25/200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albumin 25gm 100ml,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albumin 25gm Vl,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 0.083% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol Inhaler 8,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 , $745.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allegra D 24hr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allopurinol 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alosetron 1mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alphagan 0.2% Drops,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alteplase Vl 1mg,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amikacin 500mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 , $374.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 "," $1,026.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin 1gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin 2gm Inj,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 "," $1,176.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anucort-Hc 25mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aquacel  With Transparent Film,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aquaphor Oint 3oz,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 "," $2,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 , $585.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aspirin 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atenolol 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atropine 0.4mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atropine 1mg Syringe,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Augementin Xr 875mg,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aveeno Bath,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacitracin Oint,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 "," $1,595.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Beer 12oz Can,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benicar 40/12.5mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benzocaine (Oragel),,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Black Widow Antiveni Vl,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 "," $3,169.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bss Irr Soln Sol,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 , $508.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Tab : 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Captopril Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 "," $4,211.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carmex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 "," $2,205.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celestone Mdv : 6mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cetaphil Mois Lot,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 , $314.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Charcoal Liquid  25gm,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cipro 500mg Tablet,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Citrical D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 , $169.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 , $245.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 , $308.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Combigan Liquid 5ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Combivir Tablet,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Copaxone 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coumadin 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coumadin 7.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 "," $7,094.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 "," $1,566.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D10 W,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D50w 50ml Injection,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 , $452.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Danazol Cap : 200mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dapsone 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 "," $1,214.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 "," $1,057.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 "," $1,850.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 "," $1,451.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 "," $5,808.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 , $727.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 "," $1,162.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Destroxe 70% 500ml,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 10% 1000mls,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 20% 500ml,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 5% 100ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose Amp : 0.1,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 , $227.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 "," $1,568.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilacor Xr 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem 180,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dipentum Cap : 250mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 , $215.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 "," $8,438.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 "," $2,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 "," $6,604.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 "," $1,651.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 , $954.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 , $446.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 , $178.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 , $357.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ephedrine 50mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epidrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 "," $1,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 "," $1,591.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 , $921.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 , $776.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epogen 1000 Units,,,,, $904.00 , $904.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 , $614.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 "," $3,354.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 "," $1,225.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 , $512.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 "," $1,602.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythromycin 500mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 "," $1,201.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estrogens Esterified (Menest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Etodolac Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Etoposide Vl : 10mg,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 "," $1,195.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 "," $1,113.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 , $280.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrex 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flanders Butt Oin,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fleet Prep Kit #3,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 , $130.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 , $426.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 , $148.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 , $394.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 , $653.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 "," $1,015.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folic Acid 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide Xl 10mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucagon 1mg Inj,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucosamine 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Gel,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucovance 5/500,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycerin Adult Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycerin Pediatric Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycerin Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 "," $7,368.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 "," $1,020.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guiatuss Dac Syr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Halothane Liquid 250ml,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heparin Antibody,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 , $391.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 , $584.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 "," $1,681.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Icy Hot Cream Cream :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 "," $3,165.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indomethacin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 "," $3,652.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Glargine (Lantus),,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intralipids 20% 100ml,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 , $492.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 "," $1,797.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isentress 400mg Tablet,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Dinitrate,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 "," $1,273.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketamine 100mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lantus 100 Units/ML,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 "," $1,045.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levemir 100 Units/ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lice Comb Ea,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lindane Shampoo 60ml,,,,, $681.00 , $681.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 , $622.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 "," $2,385.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorcet 10/650,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorcet Plus,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 5,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 , $272.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 "," $1,213.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maalox,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magic Mouthwash,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Citrate 8oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Marinol 2.5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maxzide 50/75,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meclizine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace 400mg/10ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Melatonin 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Melatonin 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mepilex,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 , $838.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Merrem 250mg Ivpb,,,,, $690.00 , $690.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methadone 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methimazole Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metronidazole 500mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 "," $1,192.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 , $234.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miochol E Sol : 0.01,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mivacurium Inj 2mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mvp,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mysoline 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nabumetone 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nacl .9% 250ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nadolol 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naprosyn 500mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 "," $3,134.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 "," $1,073.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 "," $2,090.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 , $510.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norcuron,,,,, $886.00 , $886.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 "," $2,522.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin R 100 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolog,,,,," $2,822.00 "," $2,822.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns 1000ml Bag,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns 100ml Bag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns 250ml Adv Bag,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns 250ml Bag,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns 50ml Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns Irrigation 3000ml,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns Plus 100ml Bag,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns Plus 50ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Cream 15gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 , $449.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 "," $1,599.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 "," $1,524.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peg Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 "," $8,933.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 "," $1,999.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pentasa 250mg Capsule,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Petrolatum White Oin,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pindolol Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 , $435.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polycitra Lc Sol,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Premarin 0.625 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prenatal Vitamin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Preparation H Ointment,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Progesterone Microni (Prometri,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 "," $1,389.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protamine 50mg Amp,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 , $409.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinine 325mg Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 , $751.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 , $732.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Refresh Tears 15ml,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renagel 800mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 "," $1,694.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 , $575.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rifampin 300mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 1mg/1ml,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 , $775.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rocaltrol .25mcg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Salsalate Tab : 750mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Silver Nitrate Stick,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 "," $1,455.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 , $275.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 "," $1,622.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sorbitol 70% 30ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 , $484.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Starlix 120mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Water 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Streptomycin 1gm Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 , $288.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulindac Tab : 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulindac Tab : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Surgilube Oin : 60gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Symmetrel 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Symmetrel Syr 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 0.05mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tekturna 150mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 "," $7,624.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 , $344.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 , $685.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetracycline 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 , $560.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thrombin 5000 Unit,,,,, $937.00 , $937.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid Tab : 1grain,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 , $377.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 , $617.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin 300mg Inh,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin 80mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 , $322.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 , $419.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 "," $5,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trace Elements 5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trental 400mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 , $694.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tricor 48mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urogesic Blue Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 "," $1,023.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin 1gm Vl,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin 500mg Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vasopressin Vl : 20units,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vecuronium 10mg Inj,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil 240 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil Tab : 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vfend 200mg Tablet,,,,, $764.00 , $764.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 "," $2,499.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Viread 300mg Tablet,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vistaril 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin A 10mu Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $702.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc 10mg Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc 220mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc Oxide Ont,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $402.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 "," $1,332.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $595.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accucheck,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,A/B Otic Drops,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 15 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 30 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 5 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acarbose 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accolate 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accupril 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acidophillus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aciphex 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Actonel 35 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Actos 15 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Actos 30 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Actos 45mg,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advair,,,,, $408.00 , $408.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advair Discus 250/50,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advair Diskus Inh,,,,, $819.00 , $819.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advanced Eye Relief,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advil 200mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aerobid,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aerochamber,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aggremox Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aggrenox ER Caps,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Akwa Tears,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aldactone 25mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alendronate 35mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alendronate 70 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aleve,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Align,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allegra 180 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allegra 600 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allegra-D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Altace 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Altace 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amaryl 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amaryl 4 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ambien 10mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ambien 5mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ambilify 10 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amblify 15 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlopidine-Benaz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anafranil 25 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Analgestic Creme Rub,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anaspaz Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antacid Susp Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antioxidant Vitamins,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anusol Hc Supp,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arimidex 1 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Asacol 400 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ascensia Elite #50,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Asmanex Twisthaler,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aspercreme 10%,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Asprin 81mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atacand 16 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atacand 32 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atarex 25mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atenolol 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atenolol 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ativan 1mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ativan 2mg/ML,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atrovent Inhalation,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atrovent Inhaler,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avandia 2mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avandia 4mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avapro 150mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avelox 400mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azo Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,B-1,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Baclofen 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bactrim Ds,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $401.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benadryl 25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benadryl 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benicar 20mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benicar 40 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benicar 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztrop 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztropine 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betapace 80 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bethameth Driprop .5,,,,, $499.00 , $499.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bethanechol 50mg,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biaxin 500 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisacodyl 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biscolax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisoprolol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Black Cohosh,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blistex Lip Medex,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Boniva Tab 150,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Boost,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bumex 1mg,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspar 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspar 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspirone 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspirone 15 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspirone 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspirone 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bystolic 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calan 120 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calan Sr 180mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium 600+d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Carbonate 60,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Caltrate 600 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Campral 333 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Capoten 25mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Captopril 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Captoril 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazepine 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazepine 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardina 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardura 2 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cecon Bottle,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftin 250mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celebrex 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celebrex 200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celexa 20 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cellcept 250mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Centrum Silver Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Century 50 Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Century Senior Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cepacol Lozenges,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlestyramine Packet,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chloraseptic Spray,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorex-A Tablets,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorophyll 3mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorpromazine HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholestyramine Packs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Citalopram 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Citalopram 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Citalopram 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clarinex 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Claritin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cleocin 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clobenzaprine HCL,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine .2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrim Antifungal,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clozaril 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cogentin 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cogentin1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Col-Benemid,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Combigan Eye Drops,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Compazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Compound Rx 30gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Comtan 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Copaxone 20mg,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cordarone 200mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Corgard 40mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Corge 12.5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Corona Ointment,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Correc Cr 40mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cosopt Eye Drops,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coumadin 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cozaar 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cozaar 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cozaar 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crestor 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cymbalta 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cymbalta 30mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytra K 5ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darvocet N 100mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darvon 65mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depo Provera,,,,, $729.00 , $729.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desipramine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desyrel 100mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Detrol La 4 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diabeta 5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diclofenac Sod,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diflucan 150 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin 250mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin 50mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem ER 120,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan 160 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphedryl Sod,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divan 40mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Docusate Calcium,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Donnatel/Maalox,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxazosin Mesylate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxycycline 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dss 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dss W/Casan,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dulcolax,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duoneb 2.5,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dyazide,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dynapen 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dytan 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Effexor Xr 150mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Effient 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elavil 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $235.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elnorm 6mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril Maleate,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 "," $1,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Esidrix 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eskalith Cr,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estazolam 1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estropipate 0.625,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Etodolac 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,E-Vista 60 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Evoxac 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exelon 3mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exelon 6 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exforge 5 320mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eye Stream 30ml,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Famotidine 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Felodipine ER 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Femera 25mg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feosol,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fergon,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fexofenadine HCL,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fiber Laxative 625,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fiber Powder,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fibercon 500mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fibercon 625 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Finasteride 5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fioricet 1 Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flagyl 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flonase Nasal Spray,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $230.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flu Vaccine,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fludrocortisone Ace,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoprazine 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flurazepam,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluticasone 50mcg,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluzone,,,,, $237.00 , $237.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folamin Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foltx Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fortical Nasal Spray,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fosamax 70 Mg,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fosinopril/Hctz,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabitril 12mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Genasyme 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Genebs 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Genteal Drops,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 20 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $654.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 80 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geritol Complete,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucophage 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucotrol 5mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucovance 2.5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycolax 255 Gram,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glynase 3mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guanfucine 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 5 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 5mg/ML,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol ML 120,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hcts 1% 30gm,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humalog Ins Inj,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humulin 70/30,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrea 500 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hypotears Eye Drops,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hytrin,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,I Caps Plus,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Imdur 30 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immitrex 50 Mg,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immodium 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inderal 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inderal 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inderal La 120 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inspra 25 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Humulin R,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Invega 3 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isopto Tears,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isordil 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Nacl,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Januvia 50 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Jevity 1.5,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Juven,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K Dur 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keflex 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keflex 500mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kenalog,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $461.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keppra 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Klonopin 1 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Konsyl Powder,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Labetalol HCL,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactaid Fast Act,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamictal 100mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamictal 150mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamictal 25mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lantus Insulin 100,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lantus Insulin Inj,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Latuda 40 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Laxative Suppository,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lecithin 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lescol 20 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lescol Xl 80mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levaquin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levaquin 500mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levemir Vl,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothroid .05 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothroid 0.125,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothroid 75mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroid 25mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levthyroxine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lexapro 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lexapro 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Limbrel 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lioresal 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipitor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipitor 20 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipitor 40mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lodine 500 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lofibra,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lomox Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loniten 2.5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loperamide Hci Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lopid 600 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lopressor 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loratadine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab-5,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotensin 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovastatin 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovaza 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovenox 40mg,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loxitane 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lumigan Eye Drops,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lunesta 1 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lunesta 2 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lunesta 3 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lyrica 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lyrica 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lyrica 300 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maalox 0,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Macrobid 100mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mag Ox 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Citrate,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Oxide 241,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mavik 1 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maxzide 75/50,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medrol Dose Pak,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Susp. 5ml,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mephyton 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metaformin 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metamucil Pkt,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin 1000 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin 850 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin HCL 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methadone HCL 10mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methotrexate 25mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoclopramide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoclopramide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metolazone 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Succ,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mevacor 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miacalin 200u Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mi-Acid Gas,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Micardis 40 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Migrazone Capsules,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Minocin 100mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miralax Packet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miralex 255 Gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Moban 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Moban 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Monopril 20mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Motrin 120ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Motrin 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Motrin Susp 5ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucinex 600 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multigen Plus Caplet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multivitamin With Mineral,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Murine Tears Plus,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mylicon 80,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nadolol 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Namenda 10mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Namenda 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naphcon-A 5ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen 250 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen 500 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen Sod,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasacort Aq,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasal Solutions,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $557.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nature Tear Drops,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Navane 5 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nb Valerian Root,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neosporin Ung Pk,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neurontin 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neurontin 300 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nexium 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nexium 40 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Niacin 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nifedipine 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Niferex 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nilandon 150 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroquick,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norco 10/325 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norpramin 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norvasac 5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norvasc 10mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin 70/30,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin R 100 Units,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolog Mix 70/30,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Occuvite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Omacor 1 Gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Omnicef 300mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,One A Day,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,One-A-Day Mens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Opana ER 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orajel,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orap 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Os Cal 500d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Osteo Bi Flex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxytrol Patch,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oyster Shell Calcium,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pancrease Ec Caps,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil 20 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil Cr 12.5,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pepcid  Complete,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Periactin 4 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peridex 473ml Sol,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perparation-H Ointment,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perphenazine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan Supp,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytek 300mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pindolol 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plaquenil 200mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plavix 75mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pletac 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pletal 100mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potass Cl Meq,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravachol 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravachol 20 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravachol 40 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Precose 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisolone Acetate,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prelone 5mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Premarin Vag Cream,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Preservision Softgel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prevacid 15mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prevacid 30mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prevastatin Sod,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prisolec Otc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pristiq 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 "," $1,002.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 "," $1,815.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine Supp,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proscar 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prostate Formula,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protocream Hc 30gm,,,,, $440.00 , $440.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protonix 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protonix 40mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Provera 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Provigil 200 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prozac 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prozac 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyridoxine 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Questran Pckt 9g,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinapril 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinapril 20mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinapril 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinidine 200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ramipril 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rampipril 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranexa 500 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rapamune 1 Mg,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Razadyne 12 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Razadyne 8 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Refresh Eye Drops,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Relafen 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Remeron 15 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Remeron 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Remifemin Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reminyl 12mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip .25 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip 1mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Restoril 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rezadyne 4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rhinocort Agua,,,,, $378.00 , $378.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $932.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 1mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 2 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 4 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $946.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperidone .25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperidone .5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperidone 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperidone 4 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ritalan 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Robitussin 5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Robitussin Dm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole .25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole HCL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rozerem 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Saphris 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Saphris 5 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senna Gen Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senna Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sennalax-S Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senokot 187mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Septra Ds,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Serevent Disl Inh,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroguel 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 300 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Serzone 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shopax 100 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinemet 25/100,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinemet 25/250,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Singulair 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skelaxin 800mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slow Fe 160mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slow K-8 Meq,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sonata 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sonata 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spiriva 18mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spiriva Handihaler,,,,, $429.00 , $429.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spiriva Refill,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $660.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ssystane Eye Drops,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ST John's Wart,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Starttera 40 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stool Softner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Strattera 25 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stress W/Zinc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sumatriptan Succ,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Super Thera Vite Mt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Symbicort 80 4.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Symbyax 6/25mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Symmetrel 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid .05 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid .2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tamoxifen 10mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tapazole 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tarka 2/240,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tears Pure,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegretol 200mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tekurna 150 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Temazepam 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Temazepam 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tenex 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tenormin 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tenormin 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terazosin,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terazosin 5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terbinafine HCL 250,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theo-24 200 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theo-Dur 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theophylline 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theragran M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Therapeutic M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thermotab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiamin 50 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiamine 100 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid 2 Gr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tofranil 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tofranil 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topamax 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topiramate 100 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toprol Xl,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Torsemide 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Torsemide 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Traqzadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazadone 150 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tricor 145mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trileptal 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trilipix 45 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trimpex 100 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tums 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tussin Cough 8oz,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uloric 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ultracet 37.5/325,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ultram 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uniphyl 400mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Univasc 15mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urecholine 25mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uroxatral 10mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vantin 200 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vasotec 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vasotec 5mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil 180 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vesicare 5mg,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Viactiv Chew Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vicon C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vigamox Drops,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Visken 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin A,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B-1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D 400 U,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Volaren 1% Gel,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Voltaren 75mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Water 45 M,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Welchol 625 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Women's One A Day,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xarelto 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Z0cor 20mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zanaflex 4mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zantac 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zelform 6 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zestril 10 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zestril 20mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zestril 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zetia 10 Mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ziac 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc 50mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc Gluconate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zithromax 250 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zocor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zocor 40mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zocor 80 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zofran 4mg Tab,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zoloft 100 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zoloft 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zoloft 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zolpidem Tartrate,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zonegran 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zonisamide 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zovirax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyloprim 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyloprim 300mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 15mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexia 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyrtec 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 2 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acamprosate Calc 333,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accupril 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accupril 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accupril 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accuzyme Oint,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $559.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $632.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adderall 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adderall 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advair Diskus 100/50,,,,," $1,128.00 "," $1,128.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advair Diskus 500/50,,,,," $1,855.00 "," $1,855.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advair Hfa 115/21,,,,," $1,391.00 "," $1,391.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advil Congest Rel,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Advil Pm,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Afrin  .05 Spr,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alaway Eye Drops,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 2mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol Inhaler,,,,, $293.00 , $293.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aldactone 50 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alendronate 35 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aleve 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allegra 60 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allopurinol 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $460.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Altace 1.25 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Altace 10 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amaryl 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $613.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amikacin 500 Inj,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlactin Lotion,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amloride 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin 500mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anikacin Inj 250,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apresoline 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 "," $1,656.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arava 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aripiprazole 15mg,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Armour 90 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aromasine 25 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Artificial Tears,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $742.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aspercreme,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Astelin Nasal Spray,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atacand 8g,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atenolol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ativan 0.5 Im,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 "," $1,242.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $711.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Augmentin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avandia 8 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $733.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ayr Nasal Mist,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azilect 1 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azmacort,,,,, $607.00 , $607.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azopt Drp 1%,,,,, $482.00 , $482.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Azor 5/40 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacid Capsules,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Baclofen 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Baclofen 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Baclofen 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacmin Tab 1,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $680.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bee Pollen,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benadryl Crm 2%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benicar 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benztropine 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betamethasone Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betoptic S Ophth,,,,, $480.00 , $480.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 "," $1,129.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biotene Mouthwash,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisacodyl 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brimonidine 0.2%,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brintellix 10 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 "," $1,086.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bystolic 10 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bystolic 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calan 80 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcarb 600 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitrate 600 + D,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Carb 600mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calmoseptine Pks,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Caltrate 600 Plus,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardizem 30 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardizem 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardura 1 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardura 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carmex Lip Ointment,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Casodex 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefpodoxine 200,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftin 500 Mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cefzil 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celestone 2 ML Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celexa 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celexa 15 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celexa 40 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cellurisc 1%,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Century Senior Vitamin,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Century Vite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cepacol Throat Spray,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cephalexin Monohydra,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cerefolin,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cerefolin Nac,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cetaphil 80z,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chantix .5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chantix 1 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholestyramine Powder,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chromagen Forte,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chromium 200 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $683.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Citracal Petites,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Citrucel Each Scoop,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clarithromycin 500mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Claritin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin Oint,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $385.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine 0.1,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $447.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $349.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole 1%,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clozapine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clozaril 100 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clozaril 50 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clozipine 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clozipine 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cogentin 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colace 100mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colace 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colcrys .6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colon Clenz Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $621.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Combivent Respimat Inh,,,,," $1,335.00 "," $1,335.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Complex + Msm,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coq-10 200 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coreg 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coreg 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coreg 40 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cortef 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $436.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coumadin 6 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Creon Dr 3000 U,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crestor 20 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crestor 40 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crestor 5 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytomel 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dantrolene Sodium,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Decadron 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Delsym Each Tsp,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote 1000 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote 1500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote 750 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Deplin 15 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desipramine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desloratadine 5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Desonide Lot 0.05,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexilant 30 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dexilant 60 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dextrose 50% Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diamox 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diary Digest,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diatx Tab 1,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diflucan 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diflucan 200 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin 0.1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin 0.25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $243.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin 200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin 400 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan 320 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diovan 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ditropan 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ditropan 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Docusate Calcium 240,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $121.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin 75 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duleek Met,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dulera Inhaler,,,,," $1,241.00 "," $1,241.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duoneb 3ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ear Wax Drps,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Effexor 225 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Effexor 50 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elavil 100 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $506.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elimite Cream 5%,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eliquis 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elmiron 100,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enablex 15mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril Maleate 10,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enoxaparin 100mg,,,,, $583.00 , $583.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Entacapone 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Entacort .25 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epoetin Alfa,,,,," $4,247.00 "," $4,247.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estroven Weight Mgt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Etodolac 100mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Etodolac 400 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ex-Lax,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fanapt 1 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fanapt 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fanapt 4 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Felcainide 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feldene 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Felodipine 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fenofibrate 145mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feogen Ga,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fergon 27 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fergon 324 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flagyl 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flecainide 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flector 1.3% Patch,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flexeril 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flexeril 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Florajen Acidophilus,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Floranex Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Florastor 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flovent Hfa,,,,," $1,507.00 "," $1,507.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $625.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folacin B/6/B12,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folbee Vitiamn,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folbic,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foltanx 90 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foltrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $284.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Freshkote Eye Drps,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Furosemide 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fycompa 8 Mg,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabitril 16 Mg,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabitril 6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabitril 8 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gas X 180 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gaviscon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 10 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 10mg Injection,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 30 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glcagon Inj,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide 15 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glipizide 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucophage 250 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Tablets,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide 3 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gs Century Vits,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $58.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gynalotrimin,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hematogen Capsule,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemocyte Plus,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hum Benzoin Compound,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocort 2.5%,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $684.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,I Car-C Plus Sr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,I Vite,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Icaps M/V (Eye),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Imdur 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Imipramine 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inderal 25 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indocin 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indomethacin 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insta Glucose Gel,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Instaflex Joint Support,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Integra Vit,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 "," $2,076.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Invokana 100 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Jantoven 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Januvia 100 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Januvia 25 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,J-Tan D Sr,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K Clor 8 Meq,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K Dur 20 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K Dur 30 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K Dur 40 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K Phos,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 10 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kcl 8 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keppra 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keppra 750 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Klonopin 2 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Klor Con 10 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Klor Con 20 Meq,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Labetalol 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Labetalol 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lacrilube Oint,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactaid,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactinex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactulose 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamictal 200 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $171.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamisil,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamisil 250 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamotrigine 25mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lanacane Compound Oint,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Latuda 20 Mg,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Latuda 80 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $972.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levaquin 750 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levemir Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levemir Flexpen,,,,," $1,510.00 "," $1,510.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothroid .15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothryoxine 88mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lexapro 15 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lexapro 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lexapro 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Librium 5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipitor 80 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium Carbonate 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Livalo 2 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lodrane D24,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loperamide 2 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lopressor 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lopressor 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 2.5/500,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Losartan 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Losartan 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Losartan 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotemax Opth 5%,,,,, $657.00 , $657.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotensin 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotensin 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotensin 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loteprednol Drop,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovaza Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loxapine 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loxapine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $692.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lyrica 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lyrica 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lyrica 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maalox 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medical Food 1 Tab,,,,, $188.00 , $188.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace 60 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 "," $3,406.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megestrol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Melatonin .75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Melatonin 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Memantine HCL 10mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mestinon 60mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metafolbic Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metalozone 5 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metamucil Cap,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metanx 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin 250 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin 600mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methadone 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methadone 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metronidazole 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 "," $1,011.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Micardis 80 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midodrine 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Midrin Capsules,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Minipress 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Minocycline 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirapex 1 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mobic 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Modafinil 200 Mg,,,,, $47.00 , $47.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Monopril 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Montelukast 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine 15 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucinex D,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multaq 400 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multivitimine,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mylanta 15ml,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mylanta 30 Cc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mylanta Bottle,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mylicon 125 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nalfon 400 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naprelan 375 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen 375 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen 550 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Narco 10/325,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Narco 5/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasal Crom Spray,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nauzene,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neosporin,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neurontin 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neurontin 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neurontin 800mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neurontin 900 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neutro Phos 250mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Niacin 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine Transdermal,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nisoldipine 20mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitrolingual Spray,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norco 5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norflex 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin 100units,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolog Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Novolog Flexpen,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuedexta 20/10,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $319.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ocean Mist,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ocean Nasal Spray,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ointment 120 Com,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 5mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Omeprazole 10mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Onfi 10 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Onglyza 5 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Opcon A Eye Drops,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Optive Eye Drops,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Os Cal 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Osphena 60 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone 5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paceron 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paceron 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pamelor 50 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pamelor 75 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pancrelipase 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pangestyme Ec,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pataday Eye Drops,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Patanase Nasal Spray,,,,, $535.00 , $535.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Patanol,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $774.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paxil 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pentazocine Nalox,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pepcid 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pepcid 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Percocet 3.75/250,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Percocet 5/325,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peri Colace,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Periactin 2 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phazyme 180 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenergan W Codine,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital 60mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phentermine 37.5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pioglitazone 30mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pioglitazone 45mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plagic 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plavix 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plendil 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plendil 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ployethylene Glycol,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pneumonia Vaccine,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Ch 10meq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Phos 250,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prandin 1 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravachol 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prazosin 1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prazosin 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prazosin 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 30 ML,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prednisone 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pregabalin 25mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pregabalin 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Premarin .9 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Premarin 0.3,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Premarin Cream 30g,,,,, $978.00 , $978.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Preparation H Supposority Box,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Preservision Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prevalite Powder,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prilosec 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Primidone 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Primidone 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pristiq 100 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proamatine 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proamatine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Probenecid Colchicicine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 "," $1,277.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $725.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $274.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prograf 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prometrium 100 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promod 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol 80 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prosight,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prostat 30 Cc,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Provera 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Provigil 100 Mg,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prozac 40 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $432.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prozosin 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Psyllium See Pack,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $656.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulmocare Nutrition,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyridium 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Qnasl Nas Spray,,,,, $700.00 , $700.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Questran 2 Gm,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Questran 9gm Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinidex 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Qvar Inhal,,,,, $825.00 , $825.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ramipril 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Refresh Pm Ointment,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 "," $4,243.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Remeron 45 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renvela 800 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip .125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip 0.5mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip 4 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Resperdol 1 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Restasis 0.5%,,,,, $815.00 , $815.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Restoril 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rifampin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risamine Oint,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $257.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal 6 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $766.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 "," $1,716.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 "," $2,250.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 "," $3,147.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperidone 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Risperidone 3 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ritalin 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ritalin 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ritalin 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rivastigmine 3mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Robaxin 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Saline Flush,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sam E 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sam E 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sanctura 20mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Santyl Top,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Savella 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Selenium Shampoo,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senna 8.6mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sensipar 30 Mg,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Serax 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 500 Mg,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel 75 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sertraline 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sertraline 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Silenor 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Silvadene Cream,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Silversulfadiazine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simethicone 80 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinemet 12.5/50,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinex Nose Spray,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Singulair 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sotalol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sotalol 80mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spiriva Inhaler,,,,, $444.00 , $444.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sporanox 100 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sps Suspension 60ml,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stalevo 100 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stalevo 150 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stalevo 50 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stalevo 75 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Starlix 60 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stelazine 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stelazine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $134.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sudafed 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sudafed 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sular 17 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sular 34 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sumatriptan 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sumatriptan 25mg,,,,, $427.00 , $427.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Surmontil 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 "," $1,384.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 "," $1,029.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tagamet 400 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tamiflu,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tapazole 10 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tapazole 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tarvatan Drops,,,,, $514.00 , $514.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tavist,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegretol 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegretol 300 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegretol 400 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tekturna 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tenex 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terazosin 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theophylline 400 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theraseal Hand Cream,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tiagabine 4mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ticlid 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tigan 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tinactin Spray,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobradex Eye Oint,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobradex Opth Drops,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $451.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topamax 200 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topamax 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topiramate  25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topiramate 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toradol 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toviaz 8 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trandate 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Travoprost Eye Drops,,,,, $538.00 , $538.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone 25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tricor 48 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trilafon 8 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trileptal 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trileptal 400 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trileptal 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trileptal 75 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trilipix 135 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trospium 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tums 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tums 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tums 650 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Turmeric Curcumin,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol 325 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol 650 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol Pm,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ultracet 100,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urecholine 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urelle Tablet,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uricholine 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urimar-T Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ursodiol 300mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valisone,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valium 5 Mg Im,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid 125mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid 500mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valsartan 160,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valsartan 320 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valsartan 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valtrex 500 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $238.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil 80 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vesicare 10mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Viamin B Complex Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Viamint E 200iud,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Victoza Epipen,,,,, $821.00 , $821.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Victoza Pen Bx,,,,," $2,143.00 "," $2,143.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Viibryd 40 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vimpat 100 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vimpat 200 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vimpat 50 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Visine Eye Drops,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vistaril 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B3 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Vitamin D 50,000",,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vivactil 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vivactil 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Voltaren 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Whey Protein Isolate,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xarelto 15 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xarelto 20 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $276.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xopenex Inhaler,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Z-Gen,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zioptan Eye Drops,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zithromax 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zocor 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zofran 8 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zoloft 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zoloft 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zolpidem Cr 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $982.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zpak 250 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyrtec 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zyvox 600 Mg,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Torsemide 5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Candesartan 8 MG,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orap 1 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $197.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Norvasc 5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CEROVITE SR TABS,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BUPROPION 75 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,venlafaxine 25 mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 "," $1,474.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VYVANSE 50 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $362.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $631.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 "," $1,062.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 "," $1,405.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $3.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $728.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ULORIC 80 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CREON 12000 U,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BRILINTA 90 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FUSION PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FOLBEE PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 "," $1,194.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LINZESS 145 MCG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LATUDA 60 MG,,,,, $144.00 , $144.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,INVOKANA 300 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VIMPAT 150 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DILANTIN 30 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PREPARATION H SUPP,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,REXULTI 1 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FARXIGA 10 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,REXULTI 2 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MELATONIN 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $816.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FETZIMA 40 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FETZIMA 80 MG,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NAPCON A SOL,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MELATONIN 0.5,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $787.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LIVALO 4 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 "," $1,538.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $193.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 "," $1,766.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $199.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FE C TAB 100,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mybetriq 25 mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $1.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $2.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $79.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AZOR 10/40 MG,,,,, $49.76 , $49.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LABETALOL 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 "," $2,517.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CREON 6000 U,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,REXULTI 3 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $20.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 "," $1,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $3.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $3.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $52.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $6.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $34.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $68.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ATRIPLA,,,,, $399.80 , $399.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $13.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $1.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $1.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $3.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $59.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $818.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $61.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $1.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $4.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $131.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $51.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $3.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $445.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $2.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arginaid Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $525.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 "," $1,992.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coban,,,,, $10.32 , $10.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Descovy 200 25 mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $291.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estroven 1 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lamicatal 200 mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lisinopril 15 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $51.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $33.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $7.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metoprolol 100 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $165.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebivolol 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pataday 2% (bottle),,,,, $594.00 , $594.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pataday 2% (drop),,,,, $19.80 , $19.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $3.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $11.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Primidone 150mg,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Propranolol 20mg,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Requip 3mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Salagen 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tivicay 50 mg,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toprol 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Torsemide 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tresiba (unit),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Warfarin 40mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zocor 20mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zocor 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zoloft 200mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zonisamide 75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Naproxen 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinemet 50/200mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $63.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $3.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $540.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tandem Plus Capsule,,,,, $6.96 , $6.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $28.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $2.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LATUDA 10 MG,,,,, $99.91 , $99.91 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MULTILEX,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $202.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $195.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $13.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $7.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $31.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $26.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $9.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $188.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $1.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LINZESS 290 MCG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $2.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $113.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $2.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $37.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $21.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $5.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $14.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $257.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $56.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $55.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $23.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $43.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $17.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 "," $1,548.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pentasa 500 MG,,,,, $29.32 , $29.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CENTRATEX,,,,, $4.48 , $4.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $11.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $5.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $9.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $55.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,REXULTI 4 MG,,,,, $184.68 , $184.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $8.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $148.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $2.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $58.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $8.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $6.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $172.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,SALSALATE 500MG,,,,, $71.22 , $71.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $100.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $34.17 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $48.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $81.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $15.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuplazid 34 mg,,,,, $304.74 , $304.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 "," $1,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $8.29 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $122.61 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Infusion Therapy,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 "," $2,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $421.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $844.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $231.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,10ml Control Syringe,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,14fr Stylet Slip,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,21 Lnr Ps,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $189.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,300cc Collection Canister,,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,48  Press Moniter Line,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adapter T,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Air Hose Disposable,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Air Hose Reusable,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alcohol Prep Pads,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Algidex Ag Gauze,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Reflux Filter,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antifungal Cream,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antireflux Filter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bacteria Filter,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Scissors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $38.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Surepress Compression,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Barrier Film,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bed Air 48,,,,, $119.78 , $119.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bed Air 48  Turning,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betadine Sol 8oz,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Betadine Swabsticks,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bite Block,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $359.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bottle 100ml Saline,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bp Cuffs Medium,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bracket  Mounting,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Bridge,suture Retention",,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brief Adult Large,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bucks Traction Boot,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calazime With Olivamine,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cannula Etc02,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Cap, Trach",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carafe With Straw,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $57.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter Connector,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter Connector (Blue),,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter IV,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter Stabilization Device,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Centerpointlock Pouch,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 "," $1,068.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Tube Tray,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Clamp, Beta",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Clamp, Occluding",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Cold Pack, Instant",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $27.15 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Commode Containers,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cone Finger Separater,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cooling Blanket,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Cover, Probe",,,,, $76.32 , $76.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $259.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cup Medicine,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debridement Tray Gss,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Del Clamp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digital Termometer,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dispo-A-Probe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Disposable Headstrap,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Disposable Lead Wires,,,,, $261.82 , $261.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drain Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $58.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dycem Matting,,,,," $1,064.24 "," $1,064.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Edema Gloves 1ea,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Expiratory Filter,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 "," $2,764.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flexiseal Bag,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flexiseal Management System,,,,," $2,640.46 "," $2,640.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $10.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Forceps, Adson",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Full Face Mask Large,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Full Face Mask Medium,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Full Face Mask Small,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gair Built Blue,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $323.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Geri Chair Cushion,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gloves Large Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gloves Medium Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucerna 1.2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hair Brush,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Pitt Padded,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemostat Absorbable,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,High Flow Humidification Syste,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hip Kit,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hot Packs,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrogen Peroxide,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $135.21 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ioban Steri Drape,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Start Kit,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kerlix Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kit Suture Removal,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $157.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $220.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 "," $1,022.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee Support Brace,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Label IV Day of Week,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $97.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Large Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liquid Skin Protectant,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lotion Hand/Body,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $103.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Male External Cath-Medline,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask, Ear Loop",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask, Full Face Large",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask, Full Face Small",,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask, Nasal Small",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Med Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meplix Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Odor Eliminator Scented,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oral Care Kit,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Pack, Basic",,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Palm Cups 60mm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Palm Grip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Passy Muir Valve,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Petroleum Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pneumothorax Set,,,,," $1,244.44 "," $1,244.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Port Protector,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $118.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 "," $1,866.07 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 "," $2,014.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pressure Port for Therapep,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $101.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Razors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reacher 32,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ready-Bath,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rectal Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $596.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Set Catheter Irrigation,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoe Horn Long 24,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoulder Immobilizer,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shower Caps,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skin Closure Strips,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $42.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Soap Deodorant,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Speicmen Collection Commode,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spenco Boot--Outer,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Saline 100ml,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Sheets,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Water 1000ml,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suction Canister 1200cc,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suction Canister 2400ml,,,,, $34.98 , $34.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 "," $1,417.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suture Removal Kit,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 20cc Ll,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Syringe, Insulin",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tape Durapore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tape Measure,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tape Micropore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tape Transpore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tape Transpore 2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $186.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theraband Green,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Therapep,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theraputty Red,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theraputty Yellow,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thick & Easy,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thigh Garment Scd,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tongue Blade,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trac Y Connector,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $44.37 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Tray, Percutaneous",,,,, $629.64 , $629.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tubing Corrugated,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $18.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinal Female Guardian,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinal Male Supreme,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vac Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vent Circuit,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vest Starter Kit,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Viscopaste Pb7,,,,, $109.18 , $109.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitalstim Therapy,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Water Pitcher 22oz,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wedgesx2,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Weighted Bendable Fork,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wing Infusion 22inch,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Winged Infusion 20in,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $239.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adult Wipes,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alcohol Preps,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alldress Dressing,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Catheter,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arm Sling,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Baby Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandaid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Briefs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Comb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Connecting Tube,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Denture Adhesive,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Denture Cup,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Deodorant,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dressing Change Charge,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duoderm Dressing,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,E Cylinders,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enema Bag With Soap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ensure,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Extension Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feeding Set,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fleets Enema,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucerna,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Strip,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Graduated Container,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gt Bag,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hair and Body Shampoo,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heel Protectors,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hibiclens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Hose, Care Knee",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Introcan 22g 1 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kerlix,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kleenex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lancet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lice Treatment,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lip Balm,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Messengile Douche,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mouthwash,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nail File,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasal Cannula,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebulizer,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,No Rinse Shampoo,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,O2 Concentrator,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perineal Cleaner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Posie Pads,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Q-Tips,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shave Cream,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skin Prep Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Slipper Socks,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Soap Bar,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Speci-Hat,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Specimen Container (Sterile),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Staple Remover Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe With Needle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Telfa Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thick It,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toothbrush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toothette,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toothpaste,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tubing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Underpads,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinal,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vaseline,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vial Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vista Pump,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vista Pump Set,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wash Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Water Pitcher,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wound Cleaner,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wound Gel,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Emery Board,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Emesis Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,2 3/4  Wafer,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"4"" Kerlick",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"4""drainable Pouch",,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ace Bandage,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adult Pullups Large,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adult Pullups Medium,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adult Pullups Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bed Pan,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ben Gay,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Briefs Extra Large,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Briefs Large,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Briefs Medium,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Briefs Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Butterfly Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Autoguard 20,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Catheter, Condom",,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Catheter, Foley",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clean Catch Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colostomy Pouch,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Denture Brush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ensure Shake,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enteral Feeding Kit,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $822.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heel Suspension Boot,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Horizon Tubing,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hoyer Lift Pad,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydrogel Dressing,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ileostomy Bag,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Incentive Spirometer,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulated Water Carafe,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iodine Prep,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Pump Daily,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lubricating Jelly,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lubriderm,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medseptic Packet Each,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebulizer W/Mask,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nizoral Shampoo,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Non Adherent Pads,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ocean Spray,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Paper Tape,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Personal Belonging Bag,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Resource 8 Oz Can,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sarna Lotion,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Selson Blue Shampoo,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Speciman Cups,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Straight Catheter,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suplena 120 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 12cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 1cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 3cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 5cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ted Hose Knee High,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ted Hose Thigh High,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tinactin Powder,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Unna Boot 4""",,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vaseline Pkts,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wafer,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bariatric Bed,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Air Mattress,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trapeze Bar,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wound Vac,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bariatric Lift,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CATHETER MIDLINE,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Catheter, short term, straight",,,,," $2,543.00 "," $2,543.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blanket Bair Hugger,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,STERILE CAP MALE,,,,, $0.50 , $0.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 "," $2,713.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,B.D. Neelde,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Distilled Water,,,,, $11.19 , $11.19 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Steri Strips,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sling Arm Large,,,,, $28.18 , $28.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Collar Cervical,,,,, $84.62 , $84.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoe Post OP,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Boot Ankle Contracute,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Belt Gait 60inch,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Decannulation Plug,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $41.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abduction Wedge,,,,, $551.60 , $551.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Airway Guedel 70mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Airway Guedel 80mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $8.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Surgitube Large,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Surgitube Small,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $282.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee Immobilizer,,,,, $271.24 , $271.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $79.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $26.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $40.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $259.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $259.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $27.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $16.35 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Admission Set Up,,,,, $831.04 , $831.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cannula High Flow,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coloplast Clamps,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Control Mitt,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Isosource,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Jevity,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Juven,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Nepro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Oxepa,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Prostat,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $219.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trapeze Free Standing,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Central Line Dressing Kit,,,,, $822.48 , $822.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eclipse Injection Needle,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humid Vent 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aldosterone Bld,,,,, $938.10 , $938.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amitriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Huab,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Yob,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Benzodiazepines,,,,, $302.10 , $302.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamezipine Free,,,,, $237.44 , $237.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath for Collection,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPT Initial,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPT Subsequent,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiv-1,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lead Urine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Manual Differential,,,,, $623.28 , $623.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Microalbumin Urine,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myoglobin,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Parvo Virus Igg,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Parvo Virus Igm,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 "," $1,968.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $68.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protime,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $215.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Smear Nasal Eos,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sputum Collection,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinalysis Dipstick,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venipuncture,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,West Nile Virus Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,340 Measure Volume,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Afb Culture,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Afb Sensitivity,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ANA Titer & Pattern,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Scl 70,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antigen Type,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aso Titer,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bld Type Du,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Marrow Studies,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CBC With Auto Diff,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cell Count Csf,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlamydia by Probe,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlamydia Group Ab,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $549.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cmv Igm Ql,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crystal ID Synovial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Directogen Serum,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eosinphhil Count,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epstein Barr Ea,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epstein Barr Ebna,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epstein Barr Vca,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Era,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Febrile Agglut Each,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fecal Fat,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fibren Split Product,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fibrinogen Quan,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flow Cytometry Dna,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,H Pylori,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Handling Fee,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemo Influenza,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $348.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiv,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiv Viral Load,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiv Western Blot,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Holter Monitor 24hr,,,,, $414.00 , $414.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hpv Culture,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iep Except Serum,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iep Serum,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kell Ag Titer,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lupus Anticoagulant,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Manuel Diff,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metanephrines Urine,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Misc Immun Proc,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ob Screen,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Occult Blood,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ova Paras Smears,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pertussis Smears,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Cnt,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Count Auto,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pra,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein Electrophore,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rapid Group A Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rapid Group B Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Retic Absolute,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $397.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rocky Mountain Igg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,RPR,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,RPR Titer,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,RSV,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,SED Rate,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Semen Analysis Compl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Semen Post Vasectomy,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sickle Cell Prep,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Smear Review by Path,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urea Breath Collect,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinalysis,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinalysis Chem Only,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urine Immun Fixation,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urine Microscopic,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Varicella,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,WBC,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,West Nile Igm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wet Mount,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $546.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $701.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $719.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ova Parasites Ocp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $839.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urine 24 Hour,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urine Culture,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,WBC W Differential,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT/INR,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TPA tissue plasminogen,,,,, $136.12 , $136.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Acetone, Quant",,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Actaminophen,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acth,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acth Treatment,,,,, $467.46 , $467.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albumin Body Fluid,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alcohol Blood,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alcohol Urine,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aldolase,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $443.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alkaline Phosphatas,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amikacin,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amiodorone,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ammonia Blood,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amphetamine,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amylase Body Fluid,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amylase Isoenzyme,,,,, $723.98 , $723.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amylase Serum,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Androstenedione,,,,, $929.62 , $929.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antidiuretic Hormone,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antihistone Ab Quant,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apolipoprotein A,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apolipoprotein B,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arsenic Any Source,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,B Naturetic Peptide,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Barbiturates Quant,,,,, $445.20 , $445.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Basic Metabolic Panel,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bilirubin Direct,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bilirubin Total,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bupropion,,,,, $587.24 , $587.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,C Peptide,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Blood,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Ionized,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcium Urine 24,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carbon Diox Co2,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carboxyhemoglobin,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Carotene,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Catecholamines Total Urin,,,,, $710.20 , $710.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CEA,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ceruloplasmin,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chloride 24hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chloride Blood,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chloride Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholesterol Hdl,,,,, $201.40 , $201.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholesterol Total,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholinesterase Rbc,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 "," $1,577.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chromatography Quant,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Comp Metabolic Panel,,,,, $684.76 , $684.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Copper,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cortisol Am,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cortisol Pm,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cortisol Serum,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPK Isoenzymes,,,,, $412.34 , $412.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPK-Mb,,,,, $354.04 , $354.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $214.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Creatinine Clearance,,,,, $286.20 , $286.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Creatinine Serum,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Creatinine Urine Random,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cryoglobulin,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyanide,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyclosporine Level,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cystine Urine 24hr,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diazepam Assay,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Digoxin Lab,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dimeric Inhibin A,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doxepin (Sinequan),,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drug Screen Urine,,,,, $619.04 , $619.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Drug Screen:confirmation,,,,, $196.10 , $196.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D-Xylose,,,,, $526.82 , $526.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electroholresis-Serum,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electrolyte Panel,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Enzymatic Digestion,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Erythropoietin,,,,, $848.00 , $848.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estradiol Serum,,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estriol Unconjugate,,,,, $263.94 , $263.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estrogen Total,,,,, $694.30 , $694.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estrone,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fecal Fat Quant,,,,, $539.54 , $539.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fecal Fat Screen,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ferritin,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Folic Acid Rbc,,,,, $337.08 , $337.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Folic Acid, Serum",,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $607.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $474.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastrin Serum,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,General Health Panel,,,,," $1,186.14 "," $1,186.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gentamicin Level,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ggt,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucometer Lab,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose G6pd,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Random,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $64.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucsoe Blood,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Haptoglobin Quant,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemoglobin Electroph,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemoglobin Plasma,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemoglobin Urine,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemosiderin,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatic Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitus Panel,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Homocystine Serum,,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxyproline Free,,,,, $986.86 , $986.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immunoglobulin E,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $744.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immunolgobulin Igo,,,,, $677.34 , $677.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Impramine,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Total,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intrinsic Factor,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iron,,,,, $170.66 , $170.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iron Binding Capacity,,,,, $54.06 , $54.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketone Serum,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,L/S Ratio Quant,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactoferrin by Eia,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LDH Body Fluids,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LDH Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LDH Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lead Blood,,,,, $304.22 , $304.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lidocaine,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipase,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lipid Profile,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lithium Quan,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loh Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Loh Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Luteinizing Hormone,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Magnesium,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mercury,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $692.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methadone,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $728.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Microalbumin,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $603.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myoglobin Urine,,,,, $497.14 , $497.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Niacin Level,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nicotine,,,,, $243.80 , $243.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Noratriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nucleotidase 5,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Occult Blood Gastric,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Occult Blood Stool,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oligoclonal Bands,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Opiates Quantitative,,,,, $278.78 , $278.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Osmolality Blood,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Osmolality Urine,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Parathyroid Hormone,,,,, $422.94 , $422.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $409.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pcr Amplification,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ph Body Fluid,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenobarbital,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin Free,,,,, $536.36 , $536.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phosphatase Acid Total,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phosphatydylglycerol,,,,, $696.42 , $696.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Porphob Urine (Quant),,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Random Urine,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Serum,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pre Albumin,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Primidone (Mysoline),,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Procainamide,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Proclactin,,,,, $509.86 , $509.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Progesterone,,,,, $410.22 , $410.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein 24hr Urine,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein Phoresis Serum,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein Phoresis Urine,,,,, $345.56 , $345.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein Random Urine,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein S Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein Total,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PSA Total,,,,, $399.62 , $399.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pseudocholinesterase,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Quinidine Level,,,,, $358.28 , $358.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reducing Substance Stool,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renal Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Salicylate,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 "," $1,499.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sgot or AST,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sgpt or ALT,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Body Fluid,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Serum,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sodium Urine,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Specific Gravity -Other,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stone Analysis,,,,, $349.80 , $349.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stone Analysis Quan,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stone Rosk Citrate,,,,, $490.78 , $490.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stool for Reducing Substances,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,T-3 Free,,,,, $966.72 , $966.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,T-3 Resin Uptake,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,T-3 Total,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tacrolimus,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Testosterone Free,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Testosterone Total,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Theophylline Level,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thiamine Vit B1,,,,, $614.80 , $614.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroxine Free T4,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroxine Total T4,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tibc Without Iron,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tobramycin Test,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transferrin,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trazodone,,,,, $579.82 , $579.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tricyclic,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Triglycerides,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Troponin Quantitative,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Trypsinogen Serum,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tryptase Serum,,,,, $651.90 , $651.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tularemia Agglutinins,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uric Acid Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uric Acid Serum,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vancomycin Test,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vasopressin,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin A-Test,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B12,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $925.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin C Blood,,,,, $625.40 , $625.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 "," $1,055.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 "," $1,023.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin D Level,,,,," $1,085.44 "," $1,085.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vitamin E Serum,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vma Urine 24hr,,,,, $487.60 , $487.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Volatiles,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zinc Serum,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renin,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Acetylcholine Recep,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Albumin Serum,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amniostat,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti-Histone Abs,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Barbiturates Confir,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chloride Urine,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholinesterase,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Creatinine Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dhea S Serum,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Estrogen Level,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eth0suximide,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ethylene Glycol,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gloucose Body Fluid,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose 5 Hr,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glucose Whole Blood,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiaa Urine,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Iron Serum,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,L/S Ratio,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lactic Acid,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,LDH,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ldl Measured,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liver Profile,,,,, $521.00 , $521.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Methylmalonic Acid,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Misc Chem/Tox,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Osullivan,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Phosphorus Serum,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Potassium Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PSA Free,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Topiramate Quant,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Uric Acid Urine,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vma Urine,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Keppra Serum,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ketosteriods,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liver Function Test Lft,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ab Encephalitis California,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Adenovirus Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $175.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $498.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Aspergillus,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Blastomycosis,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Brucella,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Coccidioides,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Dna,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Elution,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $592.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Leptospira,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Rpn,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Sjogren,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antiphospholipid,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aso Screen,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bartonella Antibody,,,,, $662.50 , $662.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bences Jones Protein,,,,, $449.44 , $449.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blood Typing Rh (0),,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blood Typing Rh (D),,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bordetella Pertussis,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brucella Obortus,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,C Reactive Protein,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,C1 Esterase,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ca 125,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ca 15-3,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ca 19-9,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ca 27-29,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Calcitonin,,,,, $390.08 , $390.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cardiolipin Antibody,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Celiac Disease Antibod,,,,," $1,424.64 "," $1,424.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cell Total Count,,,,, $636.00 , $636.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlamydia Antibody,,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cie,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clotest/Culture Urine,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Complement Antigen,,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Complement C1 Function,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Complement C3 Antigen,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Complement C4 Antigen,,,,, $89.04 , $89.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Complement Total (Ch 50),,,,, $597.84 , $597.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crp Ultrasensitive,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cryptococcal Antigen,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytomegald Igg,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Direct Coombs,,,,, $137.80 , $137.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dna Antibody Single,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Du Typing Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ehrlichia Titer,,,,, $217.30 , $217.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Encephalitis East Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Encephalitis ST Louis,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epstein Barr (Ea),,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feb Agglut Ea,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feb Agglut Papa A,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feb Agglut Typh D,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Feb Agglut Typh H,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Frozen Blood Preparation,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fta-Abs,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $342.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $356.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis C Antibody,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis C Riba,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Herpes Simplex Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Herpes Simplex Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heterophile Abititer,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hla Typing B27,,,,, $649.78 , $649.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immundelectrophoresis,,,,, $363.58 , $363.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $546.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Islet Cell Antibody,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Legionella Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $310.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lyme Disease Antibody,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mhatp,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mitochondrial Antibody,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mono Test,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mumps Antibody,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Antibody,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pneumococcal Abs,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pooz Echinococcus,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Processing Autologous,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ra Titer,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rh Phenotyping,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $508.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rotavirus,,,,, $569.22 , $569.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rubella Igg,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rubella Specific Igm,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rubella Titer,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scheroderma Antibody,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $463.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 "," $1,043.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroglobulin Antib,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toxoplasma Igm,,,,, $405.98 , $405.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Varicella Igg,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Varicella Igm,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rubeola Titer,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vorl-Csf,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody ID,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Screen,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crossmatch is,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antithrombin Iii As,,,,, $771.68 , $771.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apc Resistance,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aptt,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Automated Platelet Count,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bleeding Time,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CBC Complete Automated,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coagulation Time Activ,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D Dimer,,,,, $517.28 , $517.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,D-Dimer Quantitative,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eosinophil Count,,,,, $181.26 , $181.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor 8 Level,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 "," $1,073.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor Ix Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor V Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor X Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor Xi Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor Xii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Factor Xiii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fibrinogen Activity,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hematocrit,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hematocrit Spun,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemoglobin,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $332.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kleihauer-Betke,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Morphology,,,,, $520.46 , $520.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Aggregation,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Countaiuid,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Countimanual,,,,, $146.28 , $146.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Function Assay #1,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Platelet Neutralization,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein C Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Protein S Total,,,,, $855.42 , $855.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PTT Practionated,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rbc Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reticulocyte Count,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $435.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sedrate-Westergren,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,WBC Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wnc Diff Only,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Af N Men A/Y,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Afb ID Direct Probe,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aft Smear Only,,,,, $193.98 , $193.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ag N Men C/U,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clostridium Diff Tox,,,,, $712.32 , $712.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Anaerobic,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Blood,,,,, $84.80 , $84.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Body Fluid,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Cath Tip,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Chlamydia,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Csf,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Fungus (Blood),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Fungus (Skin),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Gc Definitive,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Genital,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $311.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Herpes Typing,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Non Urine ID,,,,, $81.62 , $81.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Sputum,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Stool Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Throat,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Throat or Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Urine,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Urine ID,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Viral,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Culture Wound Aerobic,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fungus Smear,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gram Stain,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $251.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $575.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis C Quant,,,,, $250.16 , $250.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $922.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Herpes Virus Isol,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Histoplasma Antigen,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $395.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $702.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,India Ink Prep,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Influenza B by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Jc Virus by Pcr,,,,," $1,089.68 "," $1,089.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Koh Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Legionella Antigen Urine,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Malaria Smear,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $884.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neutrophil Ab,,,,, $267.12 , $267.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ova and Parasites,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pinworm Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Refacid Fast Culture,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,RSV Rapid Test,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sensitivity Mic,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Strep Group A Antigen,,,,, $206.70 , $206.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,West Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cult Fungi Other,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cult Grp B Strep,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bile Urine,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bile Urine Auto,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reducing Substance Urine,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Timed Volume Measurement,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinalysis Macro Only,,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urinalysis Micro Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Indirect Coombs,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 "," $2,905.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $230.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clinical Consult Limited,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $149.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flow Cytometry,,,,, $577.70 , $577.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fna Evaluation,,,,, $204.58 , $204.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $532.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cytology Cell Block,,,,, $281.96 , $281.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Decalcification Procedure,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $638.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pathology Consult In Surg,,,,, $815.14 , $815.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pathology Level I,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pathology Level Ii,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pathology Level Iii,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pathology Level IV,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pathology Level V,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pathology Level Vi,,,,, $617.98 , $617.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Special Stain Group Ii,,,,, $120.84 , $120.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Special Stains Group I,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Special Stains Group Ii,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abdomen 2 Views,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abdomen 3 Views,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abdomen IV (Kub),,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abdomen IV Port,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abdomen One View,,,,, $360.00 , $360.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $869.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ac Joints Bi,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ankle Complete,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Athrect Periph Artery,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Barium Enema,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Barium Enema Red Svc,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Barium Swallow,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biliary Stone Extraction,,,,, $673.00 , $673.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Age Studies,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Density Dexa,,,,, $633.00 , $633.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Survey Limited,,,,," $1,132.00 "," $1,132.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Breast Needle Local,,,,," $1,336.00 "," $1,336.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Breast Surgical Specimen,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronchography Bi X&i,,,,," $1,106.00 "," $1,106.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $991.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 "," $1,281.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 "," $1,265.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 "," $2,238.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $852.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $670.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Clavicle Complete,,,,, $373.00 , $373.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $753.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diskographylumbar S&i,,,,," $1,339.84 "," $1,339.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abdomen Complete,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ankle 2 Views,,,,, $347.00 , $347.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elbow 2v Comp,,,,, $309.52 , $309.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elbow Min 3v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Embolization Therapy,,,,," $8,848.00 "," $8,848.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Embolization Therapy S&i,,,,," $5,008.00 "," $5,008.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hip Min 2v,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foot Min 3 Views,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Forearm 2 Views,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand 2 Views,,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hip Operative Proc,,,,, $939.16 , $939.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Min 3 Views,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $334.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hip Unilat 1 View,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $576.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ercp Biliry Duct,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Esoph With Video,,,,, $890.40 , $890.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Esophagus,,,,, $557.56 , $557.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eye for Fb,,,,, $387.96 , $387.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Facial Bone 3 Views,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Femur Min 2views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Film Copy X-Ray,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $446.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 "," $1,691.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flouro More 1 Hour,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoro Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fluoro W/O Film,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foot 2 Views,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humerus Min 2v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 "," $1,105.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $475.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ivp Retrograde,,,,," $1,017.60 "," $1,017.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $948.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 "," $1,013.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ivus Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee 3 Views,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee Min 4v,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mandible 1-3v,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mandible Min 4v,,,,, $545.90 , $545.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $492.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 "," $2,428.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 "," $2,308.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 "," $2,134.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Neck Soft Tissue,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nephrostogram,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 "," $1,580.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Optic Foramina Exam,,,,, $690.06 , $690.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orbits 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orbits 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Panorex,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pelvimetry,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 "," $1,297.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 "," $3,047.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $709.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renal Angio Bilat,,,,," $3,838.26 "," $3,838.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renal Catheter Placement,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $715.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scapula (2 Views),,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scapula Complete,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sella Turcica,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoulder 1 View,,,,, $374.18 , $374.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sialography S&i,,,,, $601.02 , $601.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinuses <3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinuses 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinuses Waters View,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skull 1-3 Views,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skull Min 4v,,,,, $648.72 , $648.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Small Bowel Series,,,,," $1,602.72 "," $1,602.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $849.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $640.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Thoracic 2v,,,,, $570.28 , $570.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sternum 1v,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sternum 2 Views,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Subtraction Study,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Svc,,,,," $1,161.76 "," $1,161.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tmj Bi,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tmj Unilat,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Toes 2 Views,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 "," $1,619.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 "," $2,174.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $910.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 "," $2,999.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Upper Gi,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Upper Gi W/Air,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Upper Gi W/Kub,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ureter Stent Placement,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 "," $1,048.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 "," $1,495.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 "," $1,827.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venography Caval Inferio,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wrist 2 Views,,,,, $288.32 , $288.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xray Reading Outside,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zygomatic Arch,,,,, $393.26 , $393.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,A/C Joints Bilateral,,,,, $205.00 , $205.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ankle Ap & Lat,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Coccyx,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colon Barium,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Colon Barium W/Air,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cystogram S&i,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elbow Ap & Lat,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elbow Complete,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Elbow Complete I/F,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foot Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foot Complete I/F,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Forearm 1 Joint,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Complete I/F,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hand Two Views,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hip 2 Views I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hip Uni Two Views,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Facial Bones Comp,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Femur,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fingers,,,,, $198.00 , $198.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foot Ap & Lat,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Humerus,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee 2 Views I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee Ap and Lateral,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Knee Completed,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kub,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mandible Complete,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mandible Copl I/F,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mandible Limited,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mastoid Complete,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nasal Bones Only,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Os Calcis,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pelvis 2 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pyelogram Retro,,,,," $1,762.00 "," $1,762.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ribs Bilateral,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ribs Unilateral,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sacroiliac,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sacrum,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scapula,,,,, $216.00 , $216.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoulder 3 Views,,,,, $335.00 , $335.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoulder Compl I/F,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Shoulder Limited,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinuses Complete,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sinuses Limited,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skull Complete,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skull Complete I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skull Limited,,,,, $261.00 , $261.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $330.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Cervical Compl,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Lumb Complete,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sternaclavc Jnts,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sternum,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tempmndublr Jnts,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tibia and Fibula,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Upper Gi Series,,,,, $609.00 , $609.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venogram Unilateral,,,,," $3,111.00 "," $3,111.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wrist Ap & Lat,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wrist Complete,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bladder Scan,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Contrast Xray Uniary,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Foot Complete 3 Views,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orbit X-Ray,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 "," $3,972.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 "," $3,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Aortic Arch,,,,," $2,463.44 "," $2,463.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 "," $1,564.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 "," $1,187.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 "," $3,897.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 "," $1,618.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 "," $3,420.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 "," $2,921.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Carotid CPT,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 "," $2,033.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 "," $3,864.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 "," $3,117.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 "," $3,878.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 "," $3,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Renal Unilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Retro Brachial,,,,," $1,313.34 "," $1,313.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 "," $2,079.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 "," $1,248.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Visceral S&i,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 "," $3,919.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angiography Spinal S&i,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 "," $2,784.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 "," $2,119.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplasty Periph Art,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 "," $2,226.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arthrography Hip S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arthrography Knee S&i,,,,," $1,246.00 "," $1,246.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 "," $1,253.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Artho Shoulder,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 "," $2,454.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aorta Abdominal,,,,," $4,554.00 "," $4,554.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 "," $3,069.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 "," $3,842.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aortoram Abdominal,,,,," $1,210.52 "," $1,210.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest 1 View I/F,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Complate 4 Views,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Inspir/Exp,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Lat Decub,,,,, $438.00 , $438.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Pa 2 Views,,,,, $556.00 , $556.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Pa Single View,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Port,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest One View,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Three Views,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chest Two Views,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 "," $7,310.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $924.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Imaging Spect,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 "," $2,138.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 "," $1,503.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $889.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cisternography,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liver Funct Study,,,,," $2,514.32 "," $2,514.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Liver Scan (Spect),,,,," $2,047.92 "," $2,047.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lung Perfusion,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Lung Ventilation Scan,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 "," $1,576.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 "," $5,828.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 "," $3,110.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Parathyroid Scan,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Scan White Blood Cell,,,,," $3,372.92 "," $3,372.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 "," $2,176.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Schilling Test W/Factor,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 "," $1,020.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Testicular Imaging,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 "," $2,054.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 "," $2,684.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 "," $1,241.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tumor Local Spect,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tumor Local Whole Body,,,,," $2,575.80 "," $2,575.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastric Emptying Scan,,,,," $5,148.42 "," $5,148.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 "," $5,990.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 "," $2,805.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastrographin Liquid,,,,, $434.60 , $434.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Chest W/Con,,,,," $4,525.14 "," $4,525.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 "," $4,650.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 "," $1,108.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 "," $4,091.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Pelvis W/Con,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Facial W/O,,,,," $1,693.00 "," $1,693.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 "," $2,254.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 "," $7,418.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 "," $1,682.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Head W/Contrast,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Head W/O Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 "," $1,966.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Iac W/O Cont,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 "," $2,941.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Neck W/Contrast,,,,," $2,894.86 "," $2,894.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 "," $3,922.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $673.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Crystal Analysis,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Abd W/Con,,,,," $2,140.14 "," $2,140.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Abd W/O Con,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 "," $3,997.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Guided Needle Loc,,,,," $2,268.40 "," $2,268.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 "," $7,174.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $842.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 "," $1,992.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 "," $3,739.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 "," $3,963.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 "," $4,854.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 "," $2,595.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 "," $3,561.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 "," $3,587.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Needle Bx,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $384.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Extremity CPT,,,,, $961.42 , $961.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Peripheral CPT,,,,," $5,450.52 "," $5,450.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Renal,,,,," $3,396.24 "," $3,396.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angio Visceral CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 "," $4,096.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 "," $5,325.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplasty Iliac,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aorta Catheterization,,,,, $934.92 , $934.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aortogram Abd CPT,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Appl Unna Boot,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 "," $5,719.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 "," $3,491.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 "," $1,179.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherect Aorta Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 "," $3,442.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 "," $2,444.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 "," $2,200.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Lung,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $785.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $951.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 "," $1,744.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronchography Uni S&i,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 "," $2,339.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bx of Kidney CPT,,,,, $952.94 , $952.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 "," $3,093.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 "," $7,648.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 "," $7,369.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 "," $1,509.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $913.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 "," $3,933.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Central Venous Cath,,,,, $289.38 , $289.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $634.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 "," $2,374.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 "," $1,955.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Embol Extracranial CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Embolization CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $392.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ercp Radiology CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 "," $3,265.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $698.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,I&d Cyst Complex,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,I&d Cyst Simple,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 "," $1,930.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ins Chest Tube,,,,, $642.36 , $642.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insert Central Line Percu,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 "," $3,279.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 "," $4,208.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 "," $2,903.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 "," $5,344.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 "," $3,210.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $786.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $659.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $531.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 "," $3,668.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 "," $2,935.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 "," $2,024.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 "," $1,605.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 "," $2,245.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 "," $7,211.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 "," $3,402.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 "," $1,904.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $864.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 "," $3,612.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $899.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 "," $3,793.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Replc Picc Only Surg,,,,," $2,452.84 "," $2,452.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reposition Leads,,,,," $3,916.70 "," $3,916.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skin Biograft,,,,," $1,718.26 "," $1,718.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Skin Biograft Add-On,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Split Skin Graft,,,,," $3,782.08 "," $3,782.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Stent Placement,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 "," $1,386.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thoracentesis,,,,, $804.54 , $804.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 "," $2,257.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 "," $2,378.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 "," $2,167.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tissue Graft Other,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tracheostomy Planned,,,,," $3,892.32 "," $3,892.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 "," $1,170.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 "," $1,092.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 "," $3,390.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,General Anesthesia,,,,," $2,207.98 "," $2,207.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 "," $1,138.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $98.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Blood Admin,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Transfuse Blood Products,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Echo Routine,,,,, $768.50 , $768.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ultrasound Extremity,,,,," $1,598.48 "," $1,598.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Renal Sonogram,,,,," $1,749.00 "," $1,749.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 "," $2,414.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mammogram Special,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Echo Color Doppler,,,,, $703.84 , $703.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Echograhy Transrectal,,,,, $858.60 , $858.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 "," $1,080.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 "," $2,186.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Abdomen Complete,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Abdomen Limited,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Aorta,,,,," $1,011.24 "," $1,011.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Breast Bilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Breast Uni,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Gallbladder,,,,, $675.22 , $675.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 "," $6,321.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Kidney,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Pelvic Complete,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Pelvic Limited,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Retro Limited,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Scrotum,,,,, $747.30 , $747.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Thyroid,,,,, $711.26 , $711.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Transvaginal,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Us Chest,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Us Guide Vascular Access,,,,," $1,134.20 "," $1,134.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Us Kidney,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 "," $1,867.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Abg,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accapella Setup,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Accapella Treatment,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Arterial Puncture,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 "," $1,183.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronch Ther-Initial,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronch Ther-Subs,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronch With Biopsy,,,,," $1,828.00 "," $1,828.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bronch With Brushing,,,,," $1,620.00 "," $1,620.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $798.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Cpr-Code Blue,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Diag Bronch,,,,," $1,286.00 "," $1,286.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Intubation,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mdi Setup,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mdi Treatment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxygen Per Day,,,,, $359.00 , $359.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxygen Setup,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Patient Education,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peak Flow,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pft Pre & Post,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pft Simple,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulse Ox Setup,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rt Assessment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sputum Induction,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suction,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suction Set Up,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Updraft Set Up,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Updraft Treatments,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Vent Check-Daily,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPAP,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,CPAP Mask,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mdi,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Non Rebreather,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxygen Mask,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Suction Equip Daily,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Portable O2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulse Oximeter,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Prosthetic Training 15min,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Massage,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Re-Eval,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Therapeutic Proc,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT-E-Stim,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT-Wheelchair Main,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sensory Integration 15min,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Gait Training 15 Min,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Kinetic Excercises,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Evaluation,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Therap Group 15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Physical Ther. Activities,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Physical Therapy Procedures,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Evaluation/-Go,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Adl 15-Min,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $407.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $282.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Re-Eval - Go,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Tens Application - Go,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Speech Therapy,,,,, $308.46 , $308.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $618.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Speech Therapy Eval,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Swallow Clinical Eval,,,,, $854.00 , $854.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 "," $1,242.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 "," $1,745.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $754.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Echo 2d&m Complete,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Echo D&m Limited,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $489.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Echo Cardiogram,,,,," $4,562.00 "," $4,562.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Ambulance One Way,,,,," $1,214.76 "," $1,214.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Abd W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 "," $7,515.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 "," $6,315.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 "," $4,867.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 "," $6,631.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Brain W/Cont,,,,," $5,235.34 "," $5,235.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 "," $14,057.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Add'l Levels,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,MRI Head,,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mra Head Wo Cont,,,,," $1,312.28 "," $1,312.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 "," $1,906.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,General Recovery,,,,," $1,500.00 "," $1,500.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EKG,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EKG Rhythm Strip,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Electrocardiogram,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 "," $1,215.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 "," $1,196.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EEG Sleep Only,,,,," $1,587.88 "," $1,587.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 "," $1,988.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Mslt,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polysomnography W CPAP,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polysomnography W/4+param,,,,," $5,587.26 "," $5,587.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 "," $6,984.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EEG,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Hemodialysis,,,,, $549.08 , $549.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Peritoneal Dialysis,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Nursing Assessment,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Patient Education Group Sessio,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Educational 60 Mi,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Training Education 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 "," $4,011.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Tcp02,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,EMG Electromyograph,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Magic Vendor,Ms State Dept of Correciton,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Private Room,,,,," $1,083.00 ", $-   , $-   ," $1,800.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,Semi-Private Room,,,,," $1,051.00 ", $-   , $-   ," $1,800.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,ICU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,800.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,CCU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,800.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ", $-   , $-   , $777.00 ,,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ", $-   , $-   , $777.00 ,,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,HCPC's,90832,Individual Psychotherapy 30 Mi,,,,, $250.16 , $-   , $-   , $250.16 ,,,Not included in contract
Blue Cross,Blue Cross exclude Ms employee,HCPC's,90834,Individual Psychotherapy 45-5,,,,, $501.38 , $-   , $-   , $501.38 ,,,Not included in contract
Blue Cross,Blue Cross exclude Ms employee,HCPC's,90853,Group Psychotherapy,,,,, $326.00 , $-   , $-   , $326.00 ,,,Not included in contract
Blue Cross,Blue Cross exclude Ms employee,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ", $-   , $-   ," $147,600.00 ",,,Dailey Per Diem Avg LOS 82 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ", $-   , $-   ," $28,800.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ", $-   , $-   ," $39,600.00 ",,,Dailey Per Diem Avg LOS 22 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ", $-   , $-   ," $48,600.00 ",,,Dailey Per Diem Avg LOS 27 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ", $-   , $-   ," $55,800.00 ",,,Dailey Per Diem Avg LOS 31 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ", $-   , $-   ," $28,800.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ", $-   , $-   ," $54,000.00 ",,,Dailey Per Diem Avg LOS 30 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ", $-   , $-   ," $63,000.00 ",,,Dailey Per Diem Avg LOS 35 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,884,Organic Disturbances & Mental Retardation,,,,," $20,776.82 ", $-   , $-   ," $16,200.00 ",,,Dailey Per Diem Avg LOS 9 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,885,Psychoses,,,,," $22,724.68 ", $-   , $-   ," $19,800.00 ",,,Dailey Per Diem Avg LOS 11 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ", $-   , $-   ," $32,634.00 ",,,Dailey Per Diem Avg LOS 42 days Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,Interrupted Stay,,,,, $-   , $-   , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Code Blue,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peg Tube Placement,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perfusion 1 Hour,,,,, $369.94 , $369.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Picc Line Insertion,,,,," $2,855.64 "," $2,855.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debride Skin Full,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debride Skin Partial,,,,, $351.92 , $351.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 , $652.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 , $620.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 "," $1,240.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulsed Lavage,,,,, $184.44 , $184.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wound Care,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitiamin D 600 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,0.9% 10ml Flush,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,1eppra 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,250ml Bolus Ns,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,A&d Ointment,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 "," $3,051.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 "," $3,244.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abreva Cream 2gm,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accuzyme Oint 30gm,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acebutolol 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen 500,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen 650mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen/Codeine,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetazolamide 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetazolamide 500mg,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acyclovir 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acyclovir 500mg Inj,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acyclovir Oint 5gm,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acyclovir Susp 200mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adenosine  6mg Syri,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aggrenox 25/200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albumin 25gm 100ml,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albumin 25gm Vl,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 0.083% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol Inhaler 8,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 , $745.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allegra D 24hr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allopurinol 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alosetron 1mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alphagan 0.2% Drops,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alteplase Vl 1mg,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amikacin 500mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 , $374.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 "," $1,026.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin 1gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin 2gm Inj,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 "," $1,176.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anucort-Hc 25mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aquacel  With Transparent Film,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aquaphor Oint 3oz,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 "," $2,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 , $585.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aspirin 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atenolol 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atropine 0.4mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atropine 1mg Syringe,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Augementin Xr 875mg,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aveeno Bath,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacitracin Oint,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 "," $1,595.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Beer 12oz Can,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benicar 40/12.5mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benzocaine (Oragel),,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Black Widow Antiveni Vl,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 "," $3,169.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bss Irr Soln Sol,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 , $508.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Tab : 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Captopril Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 "," $4,211.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carmex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 "," $2,205.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celestone Mdv : 6mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cetaphil Mois Lot,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 , $314.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Charcoal Liquid  25gm,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cipro 500mg Tablet,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Citrical D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 , $169.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 , $245.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 , $308.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Combigan Liquid 5ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Combivir Tablet,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Copaxone 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coumadin 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coumadin 7.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 "," $7,094.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 "," $1,566.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D10 W,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D50w 50ml Injection,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 , $452.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Danazol Cap : 200mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dapsone 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 "," $1,214.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 "," $1,057.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 "," $1,850.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 "," $1,451.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 "," $5,808.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 , $727.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 "," $1,162.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Destroxe 70% 500ml,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 10% 1000mls,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 20% 500ml,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 5% 100ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose Amp : 0.1,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 , $227.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 "," $1,568.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilacor Xr 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem 180,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dipentum Cap : 250mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 , $215.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 "," $8,438.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 "," $2,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 "," $6,604.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 "," $1,651.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 , $954.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 , $446.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 , $178.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 , $357.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ephedrine 50mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epidrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 "," $1,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 "," $1,591.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 , $921.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 , $776.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epogen 1000 Units,,,,, $904.00 , $904.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 , $614.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 "," $3,354.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 "," $1,225.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 , $512.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 "," $1,602.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythromycin 500mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 "," $1,201.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estrogens Esterified (Menest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Etodolac Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Etoposide Vl : 10mg,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 "," $1,195.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 "," $1,113.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 , $280.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrex 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flanders Butt Oin,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fleet Prep Kit #3,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 , $130.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 , $426.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 , $148.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 , $394.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 , $653.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 "," $1,015.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folic Acid 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide Xl 10mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucagon 1mg Inj,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucosamine 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Gel,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucovance 5/500,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycerin Adult Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycerin Pediatric Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycerin Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 "," $7,368.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 "," $1,020.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guiatuss Dac Syr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Halothane Liquid 250ml,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heparin Antibody,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 , $391.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 , $584.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 "," $1,681.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Icy Hot Cream Cream :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 "," $3,165.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indomethacin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 "," $3,652.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Glargine (Lantus),,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intralipids 20% 100ml,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 , $492.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 "," $1,797.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isentress 400mg Tablet,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Dinitrate,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 "," $1,273.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketamine 100mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lantus 100 Units/ML,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 "," $1,045.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levemir 100 Units/ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lice Comb Ea,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lindane Shampoo 60ml,,,,, $681.00 , $681.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 , $622.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 "," $2,385.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorcet 10/650,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorcet Plus,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 5,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 , $272.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 "," $1,213.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maalox,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magic Mouthwash,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Citrate 8oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Marinol 2.5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maxzide 50/75,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meclizine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace 400mg/10ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Melatonin 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Melatonin 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mepilex,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 , $838.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Merrem 250mg Ivpb,,,,, $690.00 , $690.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methadone 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methimazole Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metronidazole 500mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 "," $1,192.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 , $234.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miochol E Sol : 0.01,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mivacurium Inj 2mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mvp,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mysoline 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nabumetone 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nacl .9% 250ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nadolol 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naprosyn 500mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 "," $3,134.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 "," $1,073.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 "," $2,090.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 , $510.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norcuron,,,,, $886.00 , $886.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 "," $2,522.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin R 100 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolog,,,,," $2,822.00 "," $2,822.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns 1000ml Bag,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns 100ml Bag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns 250ml Adv Bag,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns 250ml Bag,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns 50ml Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns Irrigation 3000ml,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns Plus 100ml Bag,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns Plus 50ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Cream 15gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 , $449.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 "," $1,599.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 "," $1,524.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peg Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 "," $8,933.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 "," $1,999.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pentasa 250mg Capsule,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Petrolatum White Oin,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pindolol Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 , $435.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polycitra Lc Sol,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Premarin 0.625 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prenatal Vitamin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Preparation H Ointment,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Progesterone Microni (Prometri,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 "," $1,389.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protamine 50mg Amp,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 , $409.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinine 325mg Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 , $751.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 , $732.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Refresh Tears 15ml,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renagel 800mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 "," $1,694.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 , $575.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rifampin 300mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 1mg/1ml,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 , $775.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rocaltrol .25mcg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Salsalate Tab : 750mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Silver Nitrate Stick,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 "," $1,455.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 , $275.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 "," $1,622.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sorbitol 70% 30ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 , $484.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Starlix 120mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Water 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Streptomycin 1gm Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 , $288.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulindac Tab : 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulindac Tab : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Surgilube Oin : 60gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Symmetrel 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Symmetrel Syr 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 0.05mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tekturna 150mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 "," $7,624.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 , $344.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 , $685.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetracycline 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 , $560.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thrombin 5000 Unit,,,,, $937.00 , $937.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid Tab : 1grain,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 , $377.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 , $617.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin 300mg Inh,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin 80mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 , $322.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 , $419.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 "," $5,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trace Elements 5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trental 400mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 , $694.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tricor 48mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urogesic Blue Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 "," $1,023.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin 1gm Vl,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin 500mg Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vasopressin Vl : 20units,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vecuronium 10mg Inj,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil 240 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil Tab : 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vfend 200mg Tablet,,,,, $764.00 , $764.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 "," $2,499.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Viread 300mg Tablet,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vistaril 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin A 10mu Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $702.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc 10mg Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc 220mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc Oxide Ont,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $402.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 "," $1,332.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $595.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accucheck,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,A/B Otic Drops,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 15 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 30 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 5 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acarbose 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accolate 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accupril 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acidophillus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aciphex 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Actonel 35 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Actos 15 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Actos 30 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Actos 45mg,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advair,,,,, $408.00 , $408.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advair Discus 250/50,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advair Diskus Inh,,,,, $819.00 , $819.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advanced Eye Relief,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advil 200mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aerobid,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aerochamber,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aggremox Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aggrenox ER Caps,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Akwa Tears,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aldactone 25mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alendronate 35mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alendronate 70 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aleve,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Align,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allegra 180 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allegra 600 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allegra-D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Altace 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Altace 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amaryl 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amaryl 4 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ambien 10mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ambien 5mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ambilify 10 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amblify 15 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlopidine-Benaz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anafranil 25 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Analgestic Creme Rub,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anaspaz Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antacid Susp Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antioxidant Vitamins,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anusol Hc Supp,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arimidex 1 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Asacol 400 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ascensia Elite #50,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Asmanex Twisthaler,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aspercreme 10%,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Asprin 81mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atacand 16 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atacand 32 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atarex 25mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atenolol 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atenolol 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ativan 1mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ativan 2mg/ML,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atrovent Inhalation,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atrovent Inhaler,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avandia 2mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avandia 4mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avapro 150mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avelox 400mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azo Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,B-1,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Baclofen 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bactrim Ds,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $401.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benadryl 25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benadryl 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benicar 20mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benicar 40 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benicar 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztrop 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztropine 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betapace 80 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bethameth Driprop .5,,,,, $499.00 , $499.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bethanechol 50mg,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biaxin 500 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisacodyl 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biscolax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisoprolol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Black Cohosh,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blistex Lip Medex,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Boniva Tab 150,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Boost,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bumex 1mg,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspar 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspar 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspirone 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspirone 15 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspirone 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspirone 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bystolic 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calan 120 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calan Sr 180mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium 600+d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Carbonate 60,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Caltrate 600 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Campral 333 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Capoten 25mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Captopril 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Captoril 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazepine 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazepine 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardina 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardura 2 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cecon Bottle,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftin 250mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celebrex 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celebrex 200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celexa 20 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cellcept 250mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Centrum Silver Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Century 50 Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Century Senior Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cepacol Lozenges,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlestyramine Packet,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chloraseptic Spray,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorex-A Tablets,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorophyll 3mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorpromazine HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholestyramine Packs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Citalopram 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Citalopram 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Citalopram 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clarinex 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Claritin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cleocin 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clobenzaprine HCL,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine .2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrim Antifungal,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clozaril 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cogentin 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cogentin1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Col-Benemid,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Combigan Eye Drops,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Compazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Compound Rx 30gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Comtan 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Copaxone 20mg,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cordarone 200mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Corgard 40mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Corge 12.5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Corona Ointment,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Correc Cr 40mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cosopt Eye Drops,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coumadin 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cozaar 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cozaar 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cozaar 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crestor 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cymbalta 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cymbalta 30mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytra K 5ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darvocet N 100mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darvon 65mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depo Provera,,,,, $729.00 , $729.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desipramine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desyrel 100mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Detrol La 4 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diabeta 5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diclofenac Sod,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diflucan 150 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin 250mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin 50mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem ER 120,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan 160 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphedryl Sod,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divan 40mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Docusate Calcium,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Donnatel/Maalox,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxazosin Mesylate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxycycline 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dss 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dss W/Casan,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dulcolax,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duoneb 2.5,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dyazide,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dynapen 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dytan 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Effexor Xr 150mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Effient 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elavil 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $235.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elnorm 6mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril Maleate,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 "," $1,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Esidrix 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eskalith Cr,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estazolam 1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estropipate 0.625,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Etodolac 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,E-Vista 60 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Evoxac 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exelon 3mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exelon 6 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exforge 5 320mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eye Stream 30ml,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Famotidine 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Felodipine ER 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Femera 25mg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feosol,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fergon,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fexofenadine HCL,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fiber Laxative 625,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fiber Powder,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fibercon 500mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fibercon 625 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Finasteride 5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fioricet 1 Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flagyl 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flonase Nasal Spray,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $230.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flu Vaccine,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fludrocortisone Ace,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoprazine 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flurazepam,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluticasone 50mcg,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluzone,,,,, $237.00 , $237.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folamin Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foltx Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fortical Nasal Spray,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fosamax 70 Mg,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fosinopril/Hctz,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabitril 12mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Genasyme 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Genebs 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Genteal Drops,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 20 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $654.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 80 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geritol Complete,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucophage 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucotrol 5mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucovance 2.5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycolax 255 Gram,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glynase 3mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guanfucine 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 5 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 5mg/ML,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol ML 120,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hcts 1% 30gm,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humalog Ins Inj,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humulin 70/30,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrea 500 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hypotears Eye Drops,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hytrin,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,I Caps Plus,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Imdur 30 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immitrex 50 Mg,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immodium 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inderal 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inderal 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inderal La 120 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inspra 25 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Humulin R,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Invega 3 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isopto Tears,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isordil 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Nacl,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Januvia 50 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Jevity 1.5,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Juven,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K Dur 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keflex 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keflex 500mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kenalog,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $461.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keppra 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Klonopin 1 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Konsyl Powder,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Labetalol HCL,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactaid Fast Act,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamictal 100mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamictal 150mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamictal 25mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lantus Insulin 100,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lantus Insulin Inj,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Latuda 40 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Laxative Suppository,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lecithin 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lescol 20 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lescol Xl 80mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levaquin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levaquin 500mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levemir Vl,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothroid .05 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothroid 0.125,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothroid 75mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroid 25mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levthyroxine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lexapro 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lexapro 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Limbrel 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lioresal 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipitor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipitor 20 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipitor 40mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lodine 500 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lofibra,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lomox Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loniten 2.5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loperamide Hci Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lopid 600 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lopressor 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loratadine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab-5,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotensin 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovastatin 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovaza 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovenox 40mg,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loxitane 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lumigan Eye Drops,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lunesta 1 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lunesta 2 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lunesta 3 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lyrica 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lyrica 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lyrica 300 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maalox 0,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Macrobid 100mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mag Ox 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Citrate,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Oxide 241,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mavik 1 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maxzide 75/50,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medrol Dose Pak,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Susp. 5ml,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mephyton 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metaformin 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metamucil Pkt,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin 1000 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin 850 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin HCL 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methadone HCL 10mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methotrexate 25mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoclopramide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoclopramide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metolazone 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Succ,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mevacor 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miacalin 200u Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mi-Acid Gas,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Micardis 40 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Migrazone Capsules,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Minocin 100mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miralax Packet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miralex 255 Gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Moban 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Moban 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Monopril 20mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Motrin 120ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Motrin 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Motrin Susp 5ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucinex 600 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multigen Plus Caplet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multivitamin With Mineral,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Murine Tears Plus,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mylicon 80,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nadolol 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Namenda 10mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Namenda 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naphcon-A 5ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen 250 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen 500 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen Sod,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasacort Aq,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasal Solutions,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $557.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nature Tear Drops,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Navane 5 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nb Valerian Root,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neosporin Ung Pk,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neurontin 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neurontin 300 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nexium 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nexium 40 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Niacin 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nifedipine 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Niferex 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nilandon 150 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroquick,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norco 10/325 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norpramin 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norvasac 5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norvasc 10mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin 70/30,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin R 100 Units,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolog Mix 70/30,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Occuvite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Omacor 1 Gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Omnicef 300mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,One A Day,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,One-A-Day Mens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Opana ER 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orajel,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orap 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Os Cal 500d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Osteo Bi Flex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxytrol Patch,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oyster Shell Calcium,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pancrease Ec Caps,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil 20 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil Cr 12.5,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pepcid  Complete,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Periactin 4 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peridex 473ml Sol,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perparation-H Ointment,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perphenazine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan Supp,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytek 300mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pindolol 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plaquenil 200mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plavix 75mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pletac 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pletal 100mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potass Cl Meq,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravachol 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravachol 20 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravachol 40 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Precose 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisolone Acetate,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prelone 5mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Premarin Vag Cream,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Preservision Softgel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prevacid 15mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prevacid 30mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prevastatin Sod,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prisolec Otc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pristiq 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 "," $1,002.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 "," $1,815.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine Supp,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proscar 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prostate Formula,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protocream Hc 30gm,,,,, $440.00 , $440.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protonix 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protonix 40mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Provera 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Provigil 200 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prozac 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prozac 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyridoxine 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Questran Pckt 9g,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinapril 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinapril 20mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinapril 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinidine 200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ramipril 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rampipril 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranexa 500 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rapamune 1 Mg,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Razadyne 12 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Razadyne 8 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Refresh Eye Drops,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Relafen 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Remeron 15 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Remeron 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Remifemin Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reminyl 12mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip .25 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip 1mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Restoril 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rezadyne 4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rhinocort Agua,,,,, $378.00 , $378.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $932.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 1mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 2 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 4 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $946.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperidone .25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperidone .5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperidone 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperidone 4 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ritalan 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Robitussin 5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Robitussin Dm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole .25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole HCL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rozerem 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Saphris 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Saphris 5 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senna Gen Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senna Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sennalax-S Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senokot 187mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Septra Ds,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Serevent Disl Inh,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroguel 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 300 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Serzone 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shopax 100 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinemet 25/100,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinemet 25/250,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Singulair 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skelaxin 800mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slow Fe 160mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slow K-8 Meq,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sonata 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sonata 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spiriva 18mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spiriva Handihaler,,,,, $429.00 , $429.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spiriva Refill,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $660.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ssystane Eye Drops,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ST John's Wart,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Starttera 40 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stool Softner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Strattera 25 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stress W/Zinc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sumatriptan Succ,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Super Thera Vite Mt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Symbicort 80 4.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Symbyax 6/25mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Symmetrel 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid .05 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid .2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tamoxifen 10mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tapazole 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tarka 2/240,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tears Pure,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegretol 200mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tekurna 150 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Temazepam 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Temazepam 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tenex 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tenormin 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tenormin 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terazosin,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terazosin 5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terbinafine HCL 250,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theo-24 200 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theo-Dur 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theophylline 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theragran M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Therapeutic M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thermotab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiamin 50 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiamine 100 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid 2 Gr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tofranil 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tofranil 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topamax 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topiramate 100 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toprol Xl,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Torsemide 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Torsemide 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Traqzadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazadone 150 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tricor 145mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trileptal 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trilipix 45 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trimpex 100 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tums 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tussin Cough 8oz,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uloric 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ultracet 37.5/325,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ultram 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uniphyl 400mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Univasc 15mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urecholine 25mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uroxatral 10mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vantin 200 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vasotec 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vasotec 5mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil 180 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vesicare 5mg,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Viactiv Chew Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vicon C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vigamox Drops,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Visken 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin A,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B-1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D 400 U,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Volaren 1% Gel,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Voltaren 75mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Water 45 M,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Welchol 625 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Women's One A Day,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xarelto 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Z0cor 20mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zanaflex 4mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zantac 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zelform 6 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zestril 10 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zestril 20mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zestril 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zetia 10 Mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ziac 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc 50mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc Gluconate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zithromax 250 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zocor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zocor 40mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zocor 80 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zofran 4mg Tab,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zoloft 100 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zoloft 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zoloft 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zolpidem Tartrate,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zonegran 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zonisamide 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zovirax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyloprim 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyloprim 300mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 15mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexia 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyrtec 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 2 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acamprosate Calc 333,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accupril 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accupril 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accupril 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accuzyme Oint,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $559.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $632.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adderall 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adderall 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advair Diskus 100/50,,,,," $1,128.00 "," $1,128.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advair Diskus 500/50,,,,," $1,855.00 "," $1,855.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advair Hfa 115/21,,,,," $1,391.00 "," $1,391.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advil Congest Rel,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Advil Pm,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Afrin  .05 Spr,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alaway Eye Drops,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 2mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol Inhaler,,,,, $293.00 , $293.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aldactone 50 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alendronate 35 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aleve 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allegra 60 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allopurinol 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $460.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Altace 1.25 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Altace 10 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amaryl 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $613.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amikacin 500 Inj,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlactin Lotion,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amloride 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin 500mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anikacin Inj 250,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apresoline 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 "," $1,656.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arava 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aripiprazole 15mg,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Armour 90 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aromasine 25 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Artificial Tears,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $742.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aspercreme,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Astelin Nasal Spray,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atacand 8g,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atenolol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ativan 0.5 Im,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 "," $1,242.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $711.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Augmentin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avandia 8 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $733.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ayr Nasal Mist,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azilect 1 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azmacort,,,,, $607.00 , $607.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azopt Drp 1%,,,,, $482.00 , $482.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Azor 5/40 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacid Capsules,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Baclofen 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Baclofen 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Baclofen 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacmin Tab 1,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $680.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bee Pollen,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benadryl Crm 2%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benicar 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benztropine 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betamethasone Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betoptic S Ophth,,,,, $480.00 , $480.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 "," $1,129.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biotene Mouthwash,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisacodyl 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brimonidine 0.2%,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brintellix 10 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 "," $1,086.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bystolic 10 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bystolic 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calan 80 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcarb 600 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitrate 600 + D,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Carb 600mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calmoseptine Pks,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Caltrate 600 Plus,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardizem 30 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardizem 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardura 1 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardura 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carmex Lip Ointment,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Casodex 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefpodoxine 200,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftin 500 Mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cefzil 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celestone 2 ML Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celexa 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celexa 15 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celexa 40 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cellurisc 1%,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Century Senior Vitamin,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Century Vite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cepacol Throat Spray,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cephalexin Monohydra,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cerefolin,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cerefolin Nac,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cetaphil 80z,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chantix .5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chantix 1 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholestyramine Powder,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chromagen Forte,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chromium 200 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $683.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Citracal Petites,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Citrucel Each Scoop,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clarithromycin 500mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Claritin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin Oint,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $385.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine 0.1,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $447.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $349.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole 1%,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clozapine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clozaril 100 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clozaril 50 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clozipine 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clozipine 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cogentin 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colace 100mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colace 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colcrys .6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colon Clenz Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $621.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Combivent Respimat Inh,,,,," $1,335.00 "," $1,335.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Complex + Msm,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coq-10 200 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coreg 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coreg 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coreg 40 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cortef 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $436.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coumadin 6 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Creon Dr 3000 U,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crestor 20 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crestor 40 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crestor 5 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytomel 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dantrolene Sodium,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Decadron 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Delsym Each Tsp,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote 1000 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote 1500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote 750 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Deplin 15 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desipramine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desloratadine 5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Desonide Lot 0.05,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexilant 30 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dexilant 60 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dextrose 50% Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diamox 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diary Digest,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diatx Tab 1,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diflucan 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diflucan 200 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin 0.1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin 0.25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $243.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin 200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin 400 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan 320 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diovan 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ditropan 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ditropan 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Docusate Calcium 240,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $121.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin 75 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duleek Met,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dulera Inhaler,,,,," $1,241.00 "," $1,241.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duoneb 3ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ear Wax Drps,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Effexor 225 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Effexor 50 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elavil 100 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $506.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elimite Cream 5%,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eliquis 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elmiron 100,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enablex 15mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril Maleate 10,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enoxaparin 100mg,,,,, $583.00 , $583.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Entacapone 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Entacort .25 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epoetin Alfa,,,,," $4,247.00 "," $4,247.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estroven Weight Mgt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Etodolac 100mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Etodolac 400 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ex-Lax,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fanapt 1 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fanapt 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fanapt 4 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Felcainide 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feldene 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Felodipine 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fenofibrate 145mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feogen Ga,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fergon 27 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fergon 324 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flagyl 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flecainide 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flector 1.3% Patch,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flexeril 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flexeril 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Florajen Acidophilus,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Floranex Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Florastor 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flovent Hfa,,,,," $1,507.00 "," $1,507.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $625.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folacin B/6/B12,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folbee Vitiamn,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folbic,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foltanx 90 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foltrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $284.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Freshkote Eye Drps,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Furosemide 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fycompa 8 Mg,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabitril 16 Mg,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabitril 6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabitril 8 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gas X 180 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gaviscon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 10 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 10mg Injection,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 30 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glcagon Inj,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide 15 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glipizide 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucophage 250 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Tablets,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide 3 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gs Century Vits,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $58.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gynalotrimin,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hematogen Capsule,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemocyte Plus,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hum Benzoin Compound,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocort 2.5%,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $684.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,I Car-C Plus Sr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,I Vite,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Icaps M/V (Eye),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Imdur 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Imipramine 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inderal 25 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indocin 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indomethacin 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insta Glucose Gel,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Instaflex Joint Support,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Integra Vit,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 "," $2,076.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Invokana 100 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Jantoven 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Januvia 100 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Januvia 25 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,J-Tan D Sr,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K Clor 8 Meq,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K Dur 20 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K Dur 30 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K Dur 40 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K Phos,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 10 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kcl 8 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keppra 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keppra 750 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Klonopin 2 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Klor Con 10 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Klor Con 20 Meq,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Labetalol 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Labetalol 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lacrilube Oint,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactaid,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactinex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactulose 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamictal 200 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $171.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamisil,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamisil 250 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamotrigine 25mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lanacane Compound Oint,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Latuda 20 Mg,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Latuda 80 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $972.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levaquin 750 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levemir Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levemir Flexpen,,,,," $1,510.00 "," $1,510.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothroid .15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothryoxine 88mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lexapro 15 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lexapro 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lexapro 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Librium 5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipitor 80 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium Carbonate 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Livalo 2 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lodrane D24,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loperamide 2 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lopressor 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lopressor 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 2.5/500,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Losartan 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Losartan 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Losartan 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotemax Opth 5%,,,,, $657.00 , $657.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotensin 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotensin 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotensin 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loteprednol Drop,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovaza Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loxapine 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loxapine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $692.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lyrica 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lyrica 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lyrica 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maalox 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medical Food 1 Tab,,,,, $188.00 , $188.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace 60 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 "," $3,406.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megestrol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Melatonin .75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Melatonin 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Memantine HCL 10mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mestinon 60mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metafolbic Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metalozone 5 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metamucil Cap,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metanx 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin 250 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin 600mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methadone 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methadone 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metronidazole 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 "," $1,011.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Micardis 80 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midodrine 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Midrin Capsules,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Minipress 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Minocycline 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirapex 1 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mobic 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Modafinil 200 Mg,,,,, $47.00 , $47.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Monopril 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Montelukast 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine 15 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucinex D,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multaq 400 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multivitimine,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mylanta 15ml,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mylanta 30 Cc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mylanta Bottle,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mylicon 125 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nalfon 400 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naprelan 375 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen 375 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen 550 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Narco 10/325,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Narco 5/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasal Crom Spray,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nauzene,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neosporin,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neurontin 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neurontin 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neurontin 800mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neurontin 900 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neutro Phos 250mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Niacin 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine Transdermal,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nisoldipine 20mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitrolingual Spray,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norco 5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norflex 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin 100units,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolog Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Novolog Flexpen,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuedexta 20/10,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $319.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ocean Mist,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ocean Nasal Spray,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ointment 120 Com,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 5mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Omeprazole 10mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Onfi 10 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Onglyza 5 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Opcon A Eye Drops,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Optive Eye Drops,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Os Cal 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Osphena 60 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone 5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paceron 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paceron 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pamelor 50 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pamelor 75 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pancrelipase 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pangestyme Ec,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pataday Eye Drops,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Patanase Nasal Spray,,,,, $535.00 , $535.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Patanol,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $774.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paxil 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pentazocine Nalox,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pepcid 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pepcid 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Percocet 3.75/250,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Percocet 5/325,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peri Colace,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Periactin 2 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phazyme 180 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenergan W Codine,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital 60mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phentermine 37.5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pioglitazone 30mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pioglitazone 45mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plagic 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plavix 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plendil 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plendil 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ployethylene Glycol,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pneumonia Vaccine,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Ch 10meq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Phos 250,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prandin 1 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravachol 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prazosin 1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prazosin 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prazosin 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 30 ML,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prednisone 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pregabalin 25mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pregabalin 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Premarin .9 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Premarin 0.3,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Premarin Cream 30g,,,,, $978.00 , $978.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Preparation H Supposority Box,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Preservision Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prevalite Powder,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prilosec 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Primidone 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Primidone 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pristiq 100 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proamatine 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proamatine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Probenecid Colchicicine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 "," $1,277.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $725.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $274.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prograf 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prometrium 100 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promod 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol 80 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prosight,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prostat 30 Cc,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Provera 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Provigil 100 Mg,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prozac 40 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $432.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prozosin 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Psyllium See Pack,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $656.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulmocare Nutrition,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyridium 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Qnasl Nas Spray,,,,, $700.00 , $700.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Questran 2 Gm,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Questran 9gm Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinidex 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Qvar Inhal,,,,, $825.00 , $825.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ramipril 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Refresh Pm Ointment,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 "," $4,243.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Remeron 45 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renvela 800 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip .125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip 0.5mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip 4 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Resperdol 1 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Restasis 0.5%,,,,, $815.00 , $815.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Restoril 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rifampin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risamine Oint,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $257.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal 6 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $766.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 "," $1,716.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 "," $2,250.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 "," $3,147.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperidone 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Risperidone 3 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ritalin 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ritalin 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ritalin 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rivastigmine 3mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Robaxin 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Saline Flush,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sam E 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sam E 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sanctura 20mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Santyl Top,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Savella 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Selenium Shampoo,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senna 8.6mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sensipar 30 Mg,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Serax 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 500 Mg,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel 75 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sertraline 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sertraline 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Silenor 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Silvadene Cream,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Silversulfadiazine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simethicone 80 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinemet 12.5/50,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinex Nose Spray,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Singulair 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sotalol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sotalol 80mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spiriva Inhaler,,,,, $444.00 , $444.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sporanox 100 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sps Suspension 60ml,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stalevo 100 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stalevo 150 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stalevo 50 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stalevo 75 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Starlix 60 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stelazine 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stelazine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $134.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sudafed 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sudafed 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sular 17 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sular 34 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sumatriptan 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sumatriptan 25mg,,,,, $427.00 , $427.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Surmontil 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 "," $1,384.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 "," $1,029.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tagamet 400 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tamiflu,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tapazole 10 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tapazole 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tarvatan Drops,,,,, $514.00 , $514.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tavist,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegretol 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegretol 300 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegretol 400 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tekturna 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tenex 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terazosin 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theophylline 400 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theraseal Hand Cream,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tiagabine 4mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ticlid 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tigan 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tinactin Spray,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobradex Eye Oint,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobradex Opth Drops,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $451.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topamax 200 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topamax 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topiramate  25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topiramate 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toradol 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toviaz 8 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trandate 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Travoprost Eye Drops,,,,, $538.00 , $538.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone 25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tricor 48 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trilafon 8 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trileptal 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trileptal 400 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trileptal 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trileptal 75 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trilipix 135 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trospium 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tums 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tums 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tums 650 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Turmeric Curcumin,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol 325 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol 650 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol Pm,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ultracet 100,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urecholine 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urelle Tablet,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uricholine 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urimar-T Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ursodiol 300mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valisone,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valium 5 Mg Im,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid 125mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid 500mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valsartan 160,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valsartan 320 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valsartan 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valtrex 500 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $238.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil 80 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vesicare 10mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Viamin B Complex Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Viamint E 200iud,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Victoza Epipen,,,,, $821.00 , $821.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Victoza Pen Bx,,,,," $2,143.00 "," $2,143.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Viibryd 40 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vimpat 100 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vimpat 200 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vimpat 50 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Visine Eye Drops,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vistaril 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B3 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Vitamin D 50,000",,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vivactil 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vivactil 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Voltaren 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Whey Protein Isolate,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xarelto 15 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xarelto 20 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $276.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xopenex Inhaler,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Z-Gen,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zioptan Eye Drops,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zithromax 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zocor 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zofran 8 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zoloft 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zoloft 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zolpidem Cr 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $982.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zpak 250 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyrtec 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zyvox 600 Mg,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Torsemide 5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Candesartan 8 MG,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orap 1 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $197.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Norvasc 5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CEROVITE SR TABS,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BUPROPION 75 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,venlafaxine 25 mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 "," $1,474.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VYVANSE 50 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $362.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $631.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 "," $1,062.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 "," $1,405.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $3.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $728.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ULORIC 80 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CREON 12000 U,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BRILINTA 90 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FUSION PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FOLBEE PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 "," $1,194.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LINZESS 145 MCG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LATUDA 60 MG,,,,, $144.00 , $144.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,INVOKANA 300 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VIMPAT 150 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DILANTIN 30 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PREPARATION H SUPP,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,REXULTI 1 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FARXIGA 10 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,REXULTI 2 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MELATONIN 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $816.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FETZIMA 40 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FETZIMA 80 MG,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NAPCON A SOL,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MELATONIN 0.5,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $787.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LIVALO 4 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 "," $1,538.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $193.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 "," $1,766.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $199.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FE C TAB 100,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mybetriq 25 mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $1.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $2.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $79.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AZOR 10/40 MG,,,,, $49.76 , $49.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LABETALOL 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 "," $2,517.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CREON 6000 U,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,REXULTI 3 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $20.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 "," $1,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $3.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $3.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $52.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $6.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $34.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $68.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ATRIPLA,,,,, $399.80 , $399.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $13.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $1.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $1.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $3.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $59.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $818.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $61.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $1.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $4.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $131.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $51.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $3.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $445.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $2.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arginaid Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $525.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 "," $1,992.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coban,,,,, $10.32 , $10.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Descovy 200 25 mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $291.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estroven 1 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lamicatal 200 mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lisinopril 15 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $51.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $33.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $7.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metoprolol 100 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $165.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebivolol 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pataday 2% (bottle),,,,, $594.00 , $594.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pataday 2% (drop),,,,, $19.80 , $19.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $3.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $11.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Primidone 150mg,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Propranolol 20mg,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Requip 3mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Salagen 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tivicay 50 mg,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toprol 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Torsemide 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tresiba (unit),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Warfarin 40mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zocor 20mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zocor 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zoloft 200mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zonisamide 75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Naproxen 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinemet 50/200mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $63.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $3.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $540.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tandem Plus Capsule,,,,, $6.96 , $6.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $28.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $2.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LATUDA 10 MG,,,,, $99.91 , $99.91 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MULTILEX,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $202.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $195.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $13.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $7.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $31.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $26.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $9.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $188.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $1.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LINZESS 290 MCG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $2.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $113.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $2.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $37.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $21.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $5.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $14.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $257.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $56.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $55.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $23.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $43.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $17.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 "," $1,548.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pentasa 500 MG,,,,, $29.32 , $29.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CENTRATEX,,,,, $4.48 , $4.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $11.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $5.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $9.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $55.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,REXULTI 4 MG,,,,, $184.68 , $184.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $8.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $148.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $2.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $58.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $8.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $6.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $172.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,SALSALATE 500MG,,,,, $71.22 , $71.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $100.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $34.17 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $48.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $81.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $15.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuplazid 34 mg,,,,, $304.74 , $304.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 "," $1,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $8.29 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $122.61 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Infusion Therapy,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 "," $2,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $421.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $844.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $231.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,10ml Control Syringe,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,14fr Stylet Slip,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,21 Lnr Ps,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $189.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,300cc Collection Canister,,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,48  Press Moniter Line,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adapter T,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Air Hose Disposable,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Air Hose Reusable,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alcohol Prep Pads,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Algidex Ag Gauze,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Reflux Filter,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antifungal Cream,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antireflux Filter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bacteria Filter,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Scissors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $38.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Surepress Compression,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Barrier Film,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bed Air 48,,,,, $119.78 , $119.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bed Air 48  Turning,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betadine Sol 8oz,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Betadine Swabsticks,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bite Block,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $359.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bottle 100ml Saline,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bp Cuffs Medium,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bracket  Mounting,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Bridge,suture Retention",,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brief Adult Large,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bucks Traction Boot,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calazime With Olivamine,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cannula Etc02,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Cap, Trach",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carafe With Straw,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $57.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter Connector,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter Connector (Blue),,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter IV,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter Stabilization Device,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Centerpointlock Pouch,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 "," $1,068.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Tube Tray,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Clamp, Beta",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Clamp, Occluding",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Cold Pack, Instant",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $27.15 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Commode Containers,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cone Finger Separater,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cooling Blanket,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Cover, Probe",,,,, $76.32 , $76.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $259.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cup Medicine,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debridement Tray Gss,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Del Clamp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digital Termometer,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dispo-A-Probe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Disposable Headstrap,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Disposable Lead Wires,,,,, $261.82 , $261.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drain Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $58.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dycem Matting,,,,," $1,064.24 "," $1,064.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Edema Gloves 1ea,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Expiratory Filter,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 "," $2,764.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flexiseal Bag,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flexiseal Management System,,,,," $2,640.46 "," $2,640.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $10.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Forceps, Adson",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Full Face Mask Large,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Full Face Mask Medium,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Full Face Mask Small,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gair Built Blue,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $323.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Geri Chair Cushion,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gloves Large Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gloves Medium Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucerna 1.2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hair Brush,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Pitt Padded,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemostat Absorbable,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,High Flow Humidification Syste,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hip Kit,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hot Packs,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrogen Peroxide,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $135.21 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ioban Steri Drape,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Start Kit,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kerlix Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kit Suture Removal,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $157.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $220.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 "," $1,022.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee Support Brace,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Label IV Day of Week,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $97.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Large Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liquid Skin Protectant,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lotion Hand/Body,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $103.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Male External Cath-Medline,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask, Ear Loop",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask, Full Face Large",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask, Full Face Small",,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask, Nasal Small",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Med Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meplix Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Odor Eliminator Scented,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oral Care Kit,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Pack, Basic",,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Palm Cups 60mm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Palm Grip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Passy Muir Valve,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Petroleum Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pneumothorax Set,,,,," $1,244.44 "," $1,244.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Port Protector,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $118.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 "," $1,866.07 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 "," $2,014.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pressure Port for Therapep,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $101.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Razors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reacher 32,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ready-Bath,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rectal Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $596.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Set Catheter Irrigation,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoe Horn Long 24,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoulder Immobilizer,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shower Caps,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skin Closure Strips,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $42.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Soap Deodorant,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Speicmen Collection Commode,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spenco Boot--Outer,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Saline 100ml,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Sheets,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Water 1000ml,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suction Canister 1200cc,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suction Canister 2400ml,,,,, $34.98 , $34.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 "," $1,417.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suture Removal Kit,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 20cc Ll,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Syringe, Insulin",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tape Durapore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tape Measure,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tape Micropore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tape Transpore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tape Transpore 2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $186.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theraband Green,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Therapep,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theraputty Red,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theraputty Yellow,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thick & Easy,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thigh Garment Scd,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tongue Blade,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trac Y Connector,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $44.37 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Tray, Percutaneous",,,,, $629.64 , $629.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tubing Corrugated,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $18.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinal Female Guardian,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinal Male Supreme,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vac Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vent Circuit,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vest Starter Kit,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Viscopaste Pb7,,,,, $109.18 , $109.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitalstim Therapy,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Water Pitcher 22oz,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wedgesx2,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Weighted Bendable Fork,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wing Infusion 22inch,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Winged Infusion 20in,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $239.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adult Wipes,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alcohol Preps,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alldress Dressing,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Catheter,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arm Sling,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Baby Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandaid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Briefs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Comb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Connecting Tube,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Denture Adhesive,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Denture Cup,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Deodorant,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dressing Change Charge,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duoderm Dressing,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,E Cylinders,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enema Bag With Soap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ensure,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Extension Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feeding Set,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fleets Enema,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucerna,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Strip,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Graduated Container,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gt Bag,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hair and Body Shampoo,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heel Protectors,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hibiclens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Hose, Care Knee",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Introcan 22g 1 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kerlix,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kleenex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lancet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lice Treatment,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lip Balm,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Messengile Douche,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mouthwash,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nail File,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasal Cannula,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebulizer,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,No Rinse Shampoo,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,O2 Concentrator,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perineal Cleaner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Posie Pads,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Q-Tips,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shave Cream,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skin Prep Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Slipper Socks,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Soap Bar,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Speci-Hat,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Specimen Container (Sterile),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Staple Remover Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe With Needle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Telfa Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thick It,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toothbrush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toothette,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toothpaste,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tubing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Underpads,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinal,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vaseline,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vial Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vista Pump,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vista Pump Set,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wash Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Water Pitcher,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wound Cleaner,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wound Gel,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Emery Board,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Emesis Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,2 3/4  Wafer,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"4"" Kerlick",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"4""drainable Pouch",,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ace Bandage,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adult Pullups Large,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adult Pullups Medium,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adult Pullups Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bed Pan,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ben Gay,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Briefs Extra Large,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Briefs Large,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Briefs Medium,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Briefs Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Butterfly Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Autoguard 20,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Catheter, Condom",,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Catheter, Foley",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clean Catch Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colostomy Pouch,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Denture Brush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ensure Shake,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enteral Feeding Kit,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $822.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heel Suspension Boot,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Horizon Tubing,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hoyer Lift Pad,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydrogel Dressing,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ileostomy Bag,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Incentive Spirometer,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulated Water Carafe,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iodine Prep,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Pump Daily,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lubricating Jelly,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lubriderm,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medseptic Packet Each,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebulizer W/Mask,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nizoral Shampoo,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Non Adherent Pads,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ocean Spray,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Paper Tape,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Personal Belonging Bag,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Resource 8 Oz Can,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sarna Lotion,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Selson Blue Shampoo,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Speciman Cups,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Straight Catheter,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suplena 120 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 12cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 1cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 3cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 5cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ted Hose Knee High,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ted Hose Thigh High,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tinactin Powder,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Unna Boot 4""",,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vaseline Pkts,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wafer,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bariatric Bed,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Air Mattress,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trapeze Bar,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wound Vac,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bariatric Lift,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CATHETER MIDLINE,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Catheter, short term, straight",,,,," $2,543.00 "," $2,543.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blanket Bair Hugger,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,STERILE CAP MALE,,,,, $0.50 , $0.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 "," $2,713.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,B.D. Neelde,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Distilled Water,,,,, $11.19 , $11.19 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Steri Strips,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sling Arm Large,,,,, $28.18 , $28.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Collar Cervical,,,,, $84.62 , $84.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoe Post OP,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Boot Ankle Contracute,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Belt Gait 60inch,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Decannulation Plug,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $41.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abduction Wedge,,,,, $551.60 , $551.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Airway Guedel 70mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Airway Guedel 80mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $8.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Surgitube Large,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Surgitube Small,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $282.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee Immobilizer,,,,, $271.24 , $271.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $79.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $26.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $40.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $259.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $259.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $27.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $16.35 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Admission Set Up,,,,, $831.04 , $831.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cannula High Flow,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coloplast Clamps,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Control Mitt,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Isosource,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Jevity,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Juven,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Nepro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Oxepa,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Prostat,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $219.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trapeze Free Standing,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Central Line Dressing Kit,,,,, $822.48 , $822.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eclipse Injection Needle,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humid Vent 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aldosterone Bld,,,,, $938.10 , $938.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amitriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Huab,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Yob,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Benzodiazepines,,,,, $302.10 , $302.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamezipine Free,,,,, $237.44 , $237.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath for Collection,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPT Initial,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPT Subsequent,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiv-1,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lead Urine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Manual Differential,,,,, $623.28 , $623.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Microalbumin Urine,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myoglobin,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Parvo Virus Igg,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Parvo Virus Igm,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 "," $1,968.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $68.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protime,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $215.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Smear Nasal Eos,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sputum Collection,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinalysis Dipstick,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venipuncture,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,West Nile Virus Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,340 Measure Volume,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Afb Culture,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Afb Sensitivity,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ANA Titer & Pattern,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Scl 70,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antigen Type,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aso Titer,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bld Type Du,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Marrow Studies,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CBC With Auto Diff,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cell Count Csf,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlamydia by Probe,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlamydia Group Ab,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $549.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cmv Igm Ql,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crystal ID Synovial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Directogen Serum,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eosinphhil Count,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epstein Barr Ea,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epstein Barr Ebna,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epstein Barr Vca,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Era,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Febrile Agglut Each,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fecal Fat,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fibren Split Product,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fibrinogen Quan,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flow Cytometry Dna,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,H Pylori,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Handling Fee,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemo Influenza,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $348.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiv,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiv Viral Load,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiv Western Blot,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Holter Monitor 24hr,,,,, $414.00 , $414.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hpv Culture,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iep Except Serum,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iep Serum,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kell Ag Titer,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lupus Anticoagulant,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Manuel Diff,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metanephrines Urine,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Misc Immun Proc,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ob Screen,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Occult Blood,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ova Paras Smears,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pertussis Smears,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Cnt,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Count Auto,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pra,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein Electrophore,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rapid Group A Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rapid Group B Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Retic Absolute,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $397.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rocky Mountain Igg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,RPR,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,RPR Titer,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,RSV,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,SED Rate,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Semen Analysis Compl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Semen Post Vasectomy,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sickle Cell Prep,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Smear Review by Path,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urea Breath Collect,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinalysis,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinalysis Chem Only,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urine Immun Fixation,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urine Microscopic,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Varicella,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,WBC,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,West Nile Igm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wet Mount,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $546.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $701.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $719.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ova Parasites Ocp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $839.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urine 24 Hour,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urine Culture,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,WBC W Differential,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT/INR,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TPA tissue plasminogen,,,,, $136.12 , $136.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Acetone, Quant",,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Actaminophen,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acth,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acth Treatment,,,,, $467.46 , $467.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albumin Body Fluid,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alcohol Blood,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alcohol Urine,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aldolase,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $443.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alkaline Phosphatas,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amikacin,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amiodorone,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ammonia Blood,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amphetamine,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amylase Body Fluid,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amylase Isoenzyme,,,,, $723.98 , $723.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amylase Serum,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Androstenedione,,,,, $929.62 , $929.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antidiuretic Hormone,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antihistone Ab Quant,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apolipoprotein A,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apolipoprotein B,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arsenic Any Source,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,B Naturetic Peptide,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Barbiturates Quant,,,,, $445.20 , $445.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Basic Metabolic Panel,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bilirubin Direct,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bilirubin Total,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bupropion,,,,, $587.24 , $587.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,C Peptide,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Blood,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Ionized,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcium Urine 24,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carbon Diox Co2,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carboxyhemoglobin,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Carotene,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Catecholamines Total Urin,,,,, $710.20 , $710.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CEA,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ceruloplasmin,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chloride 24hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chloride Blood,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chloride Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholesterol Hdl,,,,, $201.40 , $201.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholesterol Total,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholinesterase Rbc,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 "," $1,577.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chromatography Quant,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Comp Metabolic Panel,,,,, $684.76 , $684.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Copper,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cortisol Am,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cortisol Pm,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cortisol Serum,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPK Isoenzymes,,,,, $412.34 , $412.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPK-Mb,,,,, $354.04 , $354.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $214.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Creatinine Clearance,,,,, $286.20 , $286.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Creatinine Serum,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Creatinine Urine Random,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cryoglobulin,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyanide,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyclosporine Level,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cystine Urine 24hr,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diazepam Assay,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Digoxin Lab,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dimeric Inhibin A,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doxepin (Sinequan),,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drug Screen Urine,,,,, $619.04 , $619.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Drug Screen:confirmation,,,,, $196.10 , $196.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D-Xylose,,,,, $526.82 , $526.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electroholresis-Serum,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electrolyte Panel,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Enzymatic Digestion,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Erythropoietin,,,,, $848.00 , $848.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estradiol Serum,,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estriol Unconjugate,,,,, $263.94 , $263.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estrogen Total,,,,, $694.30 , $694.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estrone,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fecal Fat Quant,,,,, $539.54 , $539.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fecal Fat Screen,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ferritin,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Folic Acid Rbc,,,,, $337.08 , $337.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Folic Acid, Serum",,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $607.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $474.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastrin Serum,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,General Health Panel,,,,," $1,186.14 "," $1,186.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gentamicin Level,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ggt,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucometer Lab,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose G6pd,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Random,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $64.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucsoe Blood,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Haptoglobin Quant,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemoglobin Electroph,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemoglobin Plasma,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemoglobin Urine,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemosiderin,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatic Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitus Panel,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Homocystine Serum,,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxyproline Free,,,,, $986.86 , $986.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immunoglobulin E,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $744.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immunolgobulin Igo,,,,, $677.34 , $677.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Impramine,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Total,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intrinsic Factor,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iron,,,,, $170.66 , $170.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iron Binding Capacity,,,,, $54.06 , $54.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketone Serum,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,L/S Ratio Quant,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactoferrin by Eia,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LDH Body Fluids,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LDH Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LDH Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lead Blood,,,,, $304.22 , $304.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lidocaine,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipase,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lipid Profile,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lithium Quan,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loh Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Loh Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Luteinizing Hormone,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Magnesium,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mercury,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $692.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methadone,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $728.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Microalbumin,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $603.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myoglobin Urine,,,,, $497.14 , $497.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Niacin Level,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nicotine,,,,, $243.80 , $243.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Noratriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nucleotidase 5,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Occult Blood Gastric,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Occult Blood Stool,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oligoclonal Bands,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Opiates Quantitative,,,,, $278.78 , $278.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Osmolality Blood,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Osmolality Urine,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Parathyroid Hormone,,,,, $422.94 , $422.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $409.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pcr Amplification,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ph Body Fluid,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenobarbital,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin Free,,,,, $536.36 , $536.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phosphatase Acid Total,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phosphatydylglycerol,,,,, $696.42 , $696.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Porphob Urine (Quant),,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Random Urine,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Serum,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pre Albumin,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Primidone (Mysoline),,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Procainamide,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Proclactin,,,,, $509.86 , $509.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Progesterone,,,,, $410.22 , $410.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein 24hr Urine,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein Phoresis Serum,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein Phoresis Urine,,,,, $345.56 , $345.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein Random Urine,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein S Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein Total,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PSA Total,,,,, $399.62 , $399.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pseudocholinesterase,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Quinidine Level,,,,, $358.28 , $358.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reducing Substance Stool,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renal Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Salicylate,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 "," $1,499.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sgot or AST,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sgpt or ALT,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Body Fluid,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Serum,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sodium Urine,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Specific Gravity -Other,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stone Analysis,,,,, $349.80 , $349.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stone Analysis Quan,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stone Rosk Citrate,,,,, $490.78 , $490.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stool for Reducing Substances,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,T-3 Free,,,,, $966.72 , $966.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,T-3 Resin Uptake,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,T-3 Total,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tacrolimus,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Testosterone Free,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Testosterone Total,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Theophylline Level,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thiamine Vit B1,,,,, $614.80 , $614.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroxine Free T4,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroxine Total T4,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tibc Without Iron,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tobramycin Test,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transferrin,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trazodone,,,,, $579.82 , $579.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tricyclic,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Triglycerides,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Troponin Quantitative,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Trypsinogen Serum,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tryptase Serum,,,,, $651.90 , $651.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tularemia Agglutinins,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uric Acid Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uric Acid Serum,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vancomycin Test,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vasopressin,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin A-Test,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B12,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $925.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin C Blood,,,,, $625.40 , $625.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 "," $1,055.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 "," $1,023.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin D Level,,,,," $1,085.44 "," $1,085.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vitamin E Serum,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vma Urine 24hr,,,,, $487.60 , $487.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Volatiles,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zinc Serum,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renin,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Acetylcholine Recep,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Albumin Serum,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amniostat,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti-Histone Abs,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Barbiturates Confir,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chloride Urine,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholinesterase,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Creatinine Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dhea S Serum,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Estrogen Level,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eth0suximide,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ethylene Glycol,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gloucose Body Fluid,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose 5 Hr,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glucose Whole Blood,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiaa Urine,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Iron Serum,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,L/S Ratio,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lactic Acid,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,LDH,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ldl Measured,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liver Profile,,,,, $521.00 , $521.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Methylmalonic Acid,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Misc Chem/Tox,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Osullivan,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Phosphorus Serum,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Potassium Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PSA Free,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Topiramate Quant,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Uric Acid Urine,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vma Urine,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Keppra Serum,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ketosteriods,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liver Function Test Lft,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ab Encephalitis California,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Adenovirus Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $175.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $498.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Aspergillus,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Blastomycosis,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Brucella,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Coccidioides,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Dna,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Elution,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $592.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Leptospira,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Rpn,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Sjogren,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antiphospholipid,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aso Screen,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bartonella Antibody,,,,, $662.50 , $662.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bences Jones Protein,,,,, $449.44 , $449.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blood Typing Rh (0),,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blood Typing Rh (D),,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bordetella Pertussis,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brucella Obortus,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,C Reactive Protein,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,C1 Esterase,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ca 125,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ca 15-3,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ca 19-9,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ca 27-29,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Calcitonin,,,,, $390.08 , $390.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cardiolipin Antibody,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Celiac Disease Antibod,,,,," $1,424.64 "," $1,424.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cell Total Count,,,,, $636.00 , $636.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlamydia Antibody,,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cie,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clotest/Culture Urine,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Complement Antigen,,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Complement C1 Function,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Complement C3 Antigen,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Complement C4 Antigen,,,,, $89.04 , $89.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Complement Total (Ch 50),,,,, $597.84 , $597.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crp Ultrasensitive,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cryptococcal Antigen,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytomegald Igg,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Direct Coombs,,,,, $137.80 , $137.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dna Antibody Single,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Du Typing Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ehrlichia Titer,,,,, $217.30 , $217.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Encephalitis East Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Encephalitis ST Louis,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epstein Barr (Ea),,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feb Agglut Ea,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feb Agglut Papa A,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feb Agglut Typh D,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Feb Agglut Typh H,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Frozen Blood Preparation,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fta-Abs,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $342.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $356.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis C Antibody,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis C Riba,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Herpes Simplex Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Herpes Simplex Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heterophile Abititer,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hla Typing B27,,,,, $649.78 , $649.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immundelectrophoresis,,,,, $363.58 , $363.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $546.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Islet Cell Antibody,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Legionella Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $310.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lyme Disease Antibody,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mhatp,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mitochondrial Antibody,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mono Test,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mumps Antibody,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Antibody,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pneumococcal Abs,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pooz Echinococcus,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Processing Autologous,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ra Titer,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rh Phenotyping,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $508.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rotavirus,,,,, $569.22 , $569.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rubella Igg,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rubella Specific Igm,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rubella Titer,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scheroderma Antibody,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $463.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 "," $1,043.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroglobulin Antib,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toxoplasma Igm,,,,, $405.98 , $405.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Varicella Igg,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Varicella Igm,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rubeola Titer,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vorl-Csf,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody ID,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Screen,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crossmatch is,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antithrombin Iii As,,,,, $771.68 , $771.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apc Resistance,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aptt,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Automated Platelet Count,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bleeding Time,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CBC Complete Automated,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coagulation Time Activ,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D Dimer,,,,, $517.28 , $517.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,D-Dimer Quantitative,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eosinophil Count,,,,, $181.26 , $181.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor 8 Level,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 "," $1,073.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor Ix Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor V Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor X Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor Xi Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor Xii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Factor Xiii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fibrinogen Activity,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hematocrit,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hematocrit Spun,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemoglobin,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $332.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kleihauer-Betke,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Morphology,,,,, $520.46 , $520.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Aggregation,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Countaiuid,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Countimanual,,,,, $146.28 , $146.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Function Assay #1,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Platelet Neutralization,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein C Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Protein S Total,,,,, $855.42 , $855.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PTT Practionated,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rbc Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reticulocyte Count,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $435.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sedrate-Westergren,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,WBC Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wnc Diff Only,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Af N Men A/Y,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Afb ID Direct Probe,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aft Smear Only,,,,, $193.98 , $193.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ag N Men C/U,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clostridium Diff Tox,,,,, $712.32 , $712.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Anaerobic,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Blood,,,,, $84.80 , $84.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Body Fluid,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Cath Tip,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Chlamydia,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Csf,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Fungus (Blood),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Fungus (Skin),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Gc Definitive,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Genital,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $311.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Herpes Typing,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Non Urine ID,,,,, $81.62 , $81.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Sputum,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Stool Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Throat,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Throat or Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Urine,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Urine ID,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Viral,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Culture Wound Aerobic,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fungus Smear,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gram Stain,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $251.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $575.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis C Quant,,,,, $250.16 , $250.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $922.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Herpes Virus Isol,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Histoplasma Antigen,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $395.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $702.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,India Ink Prep,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Influenza B by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Jc Virus by Pcr,,,,," $1,089.68 "," $1,089.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Koh Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Legionella Antigen Urine,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Malaria Smear,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $884.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neutrophil Ab,,,,, $267.12 , $267.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ova and Parasites,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pinworm Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Refacid Fast Culture,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,RSV Rapid Test,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sensitivity Mic,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Strep Group A Antigen,,,,, $206.70 , $206.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,West Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cult Fungi Other,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cult Grp B Strep,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bile Urine,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bile Urine Auto,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reducing Substance Urine,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Timed Volume Measurement,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinalysis Macro Only,,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urinalysis Micro Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Indirect Coombs,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 "," $2,905.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $230.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clinical Consult Limited,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $149.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flow Cytometry,,,,, $577.70 , $577.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fna Evaluation,,,,, $204.58 , $204.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $532.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cytology Cell Block,,,,, $281.96 , $281.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Decalcification Procedure,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $638.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pathology Consult In Surg,,,,, $815.14 , $815.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pathology Level I,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pathology Level Ii,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pathology Level Iii,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pathology Level IV,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pathology Level V,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pathology Level Vi,,,,, $617.98 , $617.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Special Stain Group Ii,,,,, $120.84 , $120.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Special Stains Group I,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Special Stains Group Ii,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abdomen 2 Views,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abdomen 3 Views,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abdomen IV (Kub),,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abdomen IV Port,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abdomen One View,,,,, $360.00 , $360.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $869.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ac Joints Bi,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ankle Complete,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Athrect Periph Artery,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Barium Enema,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Barium Enema Red Svc,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Barium Swallow,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biliary Stone Extraction,,,,, $673.00 , $673.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Age Studies,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Density Dexa,,,,, $633.00 , $633.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Survey Limited,,,,," $1,132.00 "," $1,132.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Breast Needle Local,,,,," $1,336.00 "," $1,336.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Breast Surgical Specimen,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronchography Bi X&i,,,,," $1,106.00 "," $1,106.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $991.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 "," $1,281.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 "," $1,265.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 "," $2,238.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $852.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $670.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Clavicle Complete,,,,, $373.00 , $373.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $753.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diskographylumbar S&i,,,,," $1,339.84 "," $1,339.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abdomen Complete,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ankle 2 Views,,,,, $347.00 , $347.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elbow 2v Comp,,,,, $309.52 , $309.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elbow Min 3v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Embolization Therapy,,,,," $8,848.00 "," $8,848.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Embolization Therapy S&i,,,,," $5,008.00 "," $5,008.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hip Min 2v,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foot Min 3 Views,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Forearm 2 Views,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand 2 Views,,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hip Operative Proc,,,,, $939.16 , $939.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Min 3 Views,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $334.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hip Unilat 1 View,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $576.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ercp Biliry Duct,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Esoph With Video,,,,, $890.40 , $890.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Esophagus,,,,, $557.56 , $557.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eye for Fb,,,,, $387.96 , $387.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Facial Bone 3 Views,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Femur Min 2views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Film Copy X-Ray,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $446.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 "," $1,691.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flouro More 1 Hour,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoro Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fluoro W/O Film,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foot 2 Views,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humerus Min 2v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 "," $1,105.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $475.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ivp Retrograde,,,,," $1,017.60 "," $1,017.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $948.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 "," $1,013.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ivus Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee 3 Views,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee Min 4v,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mandible 1-3v,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mandible Min 4v,,,,, $545.90 , $545.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $492.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 "," $2,428.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 "," $2,308.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 "," $2,134.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Neck Soft Tissue,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nephrostogram,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 "," $1,580.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Optic Foramina Exam,,,,, $690.06 , $690.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orbits 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orbits 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Panorex,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pelvimetry,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 "," $1,297.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 "," $3,047.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $709.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renal Angio Bilat,,,,," $3,838.26 "," $3,838.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renal Catheter Placement,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $715.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scapula (2 Views),,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scapula Complete,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sella Turcica,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoulder 1 View,,,,, $374.18 , $374.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sialography S&i,,,,, $601.02 , $601.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinuses <3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinuses 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinuses Waters View,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skull 1-3 Views,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skull Min 4v,,,,, $648.72 , $648.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Small Bowel Series,,,,," $1,602.72 "," $1,602.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $849.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $640.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Thoracic 2v,,,,, $570.28 , $570.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sternum 1v,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sternum 2 Views,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Subtraction Study,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Svc,,,,," $1,161.76 "," $1,161.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tmj Bi,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tmj Unilat,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Toes 2 Views,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 "," $1,619.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 "," $2,174.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $910.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 "," $2,999.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Upper Gi,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Upper Gi W/Air,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Upper Gi W/Kub,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ureter Stent Placement,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 "," $1,048.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 "," $1,495.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 "," $1,827.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venography Caval Inferio,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wrist 2 Views,,,,, $288.32 , $288.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xray Reading Outside,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zygomatic Arch,,,,, $393.26 , $393.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,A/C Joints Bilateral,,,,, $205.00 , $205.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ankle Ap & Lat,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Coccyx,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colon Barium,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Colon Barium W/Air,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cystogram S&i,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elbow Ap & Lat,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elbow Complete,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Elbow Complete I/F,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foot Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foot Complete I/F,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Forearm 1 Joint,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Complete I/F,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hand Two Views,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hip 2 Views I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hip Uni Two Views,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Facial Bones Comp,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Femur,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fingers,,,,, $198.00 , $198.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foot Ap & Lat,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Humerus,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee 2 Views I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee Ap and Lateral,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Knee Completed,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kub,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mandible Complete,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mandible Copl I/F,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mandible Limited,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mastoid Complete,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nasal Bones Only,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Os Calcis,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pelvis 2 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pyelogram Retro,,,,," $1,762.00 "," $1,762.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ribs Bilateral,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ribs Unilateral,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sacroiliac,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sacrum,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scapula,,,,, $216.00 , $216.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoulder 3 Views,,,,, $335.00 , $335.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoulder Compl I/F,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Shoulder Limited,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinuses Complete,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sinuses Limited,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skull Complete,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skull Complete I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skull Limited,,,,, $261.00 , $261.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $330.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Cervical Compl,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Lumb Complete,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sternaclavc Jnts,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sternum,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tempmndublr Jnts,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tibia and Fibula,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Upper Gi Series,,,,, $609.00 , $609.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venogram Unilateral,,,,," $3,111.00 "," $3,111.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wrist Ap & Lat,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wrist Complete,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bladder Scan,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Contrast Xray Uniary,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Foot Complete 3 Views,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orbit X-Ray,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 "," $3,972.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 "," $3,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Aortic Arch,,,,," $2,463.44 "," $2,463.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 "," $1,564.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 "," $1,187.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 "," $3,897.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 "," $1,618.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 "," $3,420.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 "," $2,921.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Carotid CPT,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 "," $2,033.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 "," $3,864.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 "," $3,117.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 "," $3,878.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 "," $3,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Renal Unilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Retro Brachial,,,,," $1,313.34 "," $1,313.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 "," $2,079.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 "," $1,248.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Visceral S&i,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 "," $3,919.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angiography Spinal S&i,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 "," $2,784.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 "," $2,119.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplasty Periph Art,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 "," $2,226.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arthrography Hip S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arthrography Knee S&i,,,,," $1,246.00 "," $1,246.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 "," $1,253.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Artho Shoulder,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 "," $2,454.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aorta Abdominal,,,,," $4,554.00 "," $4,554.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 "," $3,069.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 "," $3,842.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aortoram Abdominal,,,,," $1,210.52 "," $1,210.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest 1 View I/F,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Complate 4 Views,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Inspir/Exp,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Lat Decub,,,,, $438.00 , $438.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Pa 2 Views,,,,, $556.00 , $556.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Pa Single View,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Port,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest One View,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Three Views,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chest Two Views,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 "," $7,310.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $924.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Imaging Spect,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 "," $2,138.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 "," $1,503.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $889.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cisternography,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liver Funct Study,,,,," $2,514.32 "," $2,514.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Liver Scan (Spect),,,,," $2,047.92 "," $2,047.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lung Perfusion,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Lung Ventilation Scan,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 "," $1,576.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 "," $5,828.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 "," $3,110.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Parathyroid Scan,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Scan White Blood Cell,,,,," $3,372.92 "," $3,372.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 "," $2,176.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Schilling Test W/Factor,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 "," $1,020.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Testicular Imaging,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 "," $2,054.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 "," $2,684.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 "," $1,241.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tumor Local Spect,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tumor Local Whole Body,,,,," $2,575.80 "," $2,575.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastric Emptying Scan,,,,," $5,148.42 "," $5,148.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 "," $5,990.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 "," $2,805.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastrographin Liquid,,,,, $434.60 , $434.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Chest W/Con,,,,," $4,525.14 "," $4,525.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 "," $4,650.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 "," $1,108.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 "," $4,091.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Pelvis W/Con,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Facial W/O,,,,," $1,693.00 "," $1,693.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 "," $2,254.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 "," $7,418.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 "," $1,682.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Head W/Contrast,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Head W/O Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 "," $1,966.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Iac W/O Cont,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 "," $2,941.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Neck W/Contrast,,,,," $2,894.86 "," $2,894.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 "," $3,922.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $673.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Crystal Analysis,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Abd W/Con,,,,," $2,140.14 "," $2,140.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Abd W/O Con,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 "," $3,997.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Guided Needle Loc,,,,," $2,268.40 "," $2,268.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 "," $7,174.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $842.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 "," $1,992.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 "," $3,739.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 "," $3,963.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 "," $4,854.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 "," $2,595.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 "," $3,561.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 "," $3,587.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Needle Bx,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $384.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Extremity CPT,,,,, $961.42 , $961.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Peripheral CPT,,,,," $5,450.52 "," $5,450.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Renal,,,,," $3,396.24 "," $3,396.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angio Visceral CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 "," $4,096.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 "," $5,325.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplasty Iliac,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aorta Catheterization,,,,, $934.92 , $934.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aortogram Abd CPT,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Appl Unna Boot,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 "," $5,719.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 "," $3,491.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 "," $1,179.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherect Aorta Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 "," $3,442.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 "," $2,444.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 "," $2,200.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Lung,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $785.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $951.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 "," $1,744.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronchography Uni S&i,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 "," $2,339.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bx of Kidney CPT,,,,, $952.94 , $952.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 "," $3,093.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 "," $7,648.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 "," $7,369.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 "," $1,509.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $913.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 "," $3,933.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Central Venous Cath,,,,, $289.38 , $289.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $634.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 "," $2,374.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 "," $1,955.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Embol Extracranial CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Embolization CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $392.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ercp Radiology CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 "," $3,265.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $698.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,I&d Cyst Complex,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,I&d Cyst Simple,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 "," $1,930.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ins Chest Tube,,,,, $642.36 , $642.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insert Central Line Percu,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 "," $3,279.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 "," $4,208.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 "," $2,903.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 "," $5,344.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 "," $3,210.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $786.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $659.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $531.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 "," $3,668.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 "," $2,935.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 "," $2,024.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 "," $1,605.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 "," $2,245.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 "," $7,211.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 "," $3,402.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 "," $1,904.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $864.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 "," $3,612.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $899.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 "," $3,793.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Replc Picc Only Surg,,,,," $2,452.84 "," $2,452.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reposition Leads,,,,," $3,916.70 "," $3,916.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skin Biograft,,,,," $1,718.26 "," $1,718.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Skin Biograft Add-On,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Split Skin Graft,,,,," $3,782.08 "," $3,782.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Stent Placement,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 "," $1,386.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thoracentesis,,,,, $804.54 , $804.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 "," $2,257.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 "," $2,378.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 "," $2,167.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tissue Graft Other,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tracheostomy Planned,,,,," $3,892.32 "," $3,892.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 "," $1,170.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 "," $1,092.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 "," $3,390.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,General Anesthesia,,,,," $2,207.98 "," $2,207.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 "," $1,138.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $98.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Blood Admin,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Transfuse Blood Products,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Echo Routine,,,,, $768.50 , $768.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ultrasound Extremity,,,,," $1,598.48 "," $1,598.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Renal Sonogram,,,,," $1,749.00 "," $1,749.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 "," $2,414.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mammogram Special,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Echo Color Doppler,,,,, $703.84 , $703.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Echograhy Transrectal,,,,, $858.60 , $858.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 "," $1,080.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 "," $2,186.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Abdomen Complete,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Abdomen Limited,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Aorta,,,,," $1,011.24 "," $1,011.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Breast Bilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Breast Uni,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Gallbladder,,,,, $675.22 , $675.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 "," $6,321.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Kidney,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Pelvic Complete,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Pelvic Limited,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Retro Limited,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Scrotum,,,,, $747.30 , $747.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Thyroid,,,,, $711.26 , $711.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Transvaginal,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Us Chest,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Us Guide Vascular Access,,,,," $1,134.20 "," $1,134.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Us Kidney,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 "," $1,867.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Abg,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accapella Setup,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Accapella Treatment,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Arterial Puncture,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 "," $1,183.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronch Ther-Initial,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronch Ther-Subs,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronch With Biopsy,,,,," $1,828.00 "," $1,828.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bronch With Brushing,,,,," $1,620.00 "," $1,620.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $798.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Cpr-Code Blue,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Diag Bronch,,,,," $1,286.00 "," $1,286.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Intubation,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mdi Setup,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mdi Treatment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxygen Per Day,,,,, $359.00 , $359.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxygen Setup,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Patient Education,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peak Flow,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pft Pre & Post,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pft Simple,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulse Ox Setup,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rt Assessment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sputum Induction,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suction,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suction Set Up,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Updraft Set Up,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Updraft Treatments,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Vent Check-Daily,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPAP,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,CPAP Mask,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mdi,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Non Rebreather,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxygen Mask,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Suction Equip Daily,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Portable O2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulse Oximeter,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Prosthetic Training 15min,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Massage,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Re-Eval,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Therapeutic Proc,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT-E-Stim,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT-Wheelchair Main,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sensory Integration 15min,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Gait Training 15 Min,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Kinetic Excercises,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Evaluation,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Therap Group 15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Physical Ther. Activities,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Physical Therapy Procedures,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Evaluation/-Go,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Adl 15-Min,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $407.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $282.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Re-Eval - Go,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Tens Application - Go,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Speech Therapy,,,,, $308.46 , $308.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $618.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Speech Therapy Eval,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Swallow Clinical Eval,,,,, $854.00 , $854.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 "," $1,242.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 "," $1,745.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $754.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Echo 2d&m Complete,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Echo D&m Limited,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $489.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Echo Cardiogram,,,,," $4,562.00 "," $4,562.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Ambulance One Way,,,,," $1,214.76 "," $1,214.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Abd W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 "," $7,515.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 "," $6,315.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 "," $4,867.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 "," $6,631.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Brain W/Cont,,,,," $5,235.34 "," $5,235.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 "," $14,057.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Add'l Levels,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,MRI Head,,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mra Head Wo Cont,,,,," $1,312.28 "," $1,312.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 "," $1,906.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,General Recovery,,,,," $1,500.00 "," $1,500.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EKG,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EKG Rhythm Strip,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Electrocardiogram,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 "," $1,215.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 "," $1,196.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EEG Sleep Only,,,,," $1,587.88 "," $1,587.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 "," $1,988.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Mslt,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polysomnography W CPAP,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polysomnography W/4+param,,,,," $5,587.26 "," $5,587.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 "," $6,984.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EEG,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Hemodialysis,,,,, $549.08 , $549.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Peritoneal Dialysis,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Nursing Assessment,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Patient Education Group Sessio,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Educational 60 Mi,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Training Education 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 "," $4,011.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Tcp02,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,EMG Electromyograph,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross exclude Ms employee,DRG,,Private Room,,,,," $1,083.00 ", $-   , $-   ," $1,100.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,Semi-Private Room,,,,," $1,051.00 ", $-   , $-   ," $1,100.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,ICU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,100.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,CCU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,100.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ", $-   , $-   , $850.00 ,,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ", $-   , $-   , $850.00 ,,,Plan pays daily Per Diem Rate Pro Fees not included
Blue Cross,Blue Cross exclude Ms employee,HCPC's,90832,Individual Psychotherapy 30 Mi,,,,, $250.16 , $-   , $-   , $250.16 ,,,Not included in contract
Blue Cross,Blue Cross exclude Ms employee,HCPC's,90834,Individual Psychotherapy 45-5,,,,, $501.38 , $-   , $-   , $501.38 ,,,Not included in contract
Blue Cross,Blue Cross exclude Ms employee,HCPC's,90853,Group Psychotherapy,,,,, $326.00 , $-   , $-   , $326.00 ,,,Not included in contract
Blue Cross,Blue Cross Ms employee,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ", $-   , $-   ," $90,200.00 ",,,Dailey Per Diem Avg LOS 82 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ", $-   , $-   ," $17,600.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ", $-   , $-   ," $24,200.00 ",,,Dailey Per Diem Avg LOS 22 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ", $-   , $-   ," $29,700.00 ",,,Dailey Per Diem Avg LOS 27 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ", $-   , $-   ," $34,100.00 ",,,Dailey Per Diem Avg LOS 31 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ", $-   , $-   ," $17,600.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ", $-   , $-   ," $33,000.00 ",,,Dailey Per Diem Avg LOS 30 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ", $-   , $-   ," $38,500.00 ",,,Dailey Per Diem Avg LOS 35 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,884,Organic Disturbances & Mental Retardation,,,,," $20,776.82 ", $-   , $-   ," $9,900.00 ",,,Dailey Per Diem Avg LOS 9 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,885,Psychoses,,,,," $22,724.68 ", $-   , $-   ," $12,100.00 ",,,Dailey Per Diem Avg LOS 11 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ", $-   , $-   ," $35,700.00 ",,,Dailey Per Diem Avg LOS 42 days Pro Fees not included
Blue Cross,Blue Cross Ms employee,DRG,,Interrupted Stay,,,,, $-   , $-   , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Code Blue,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peg Tube Placement,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perfusion 1 Hour,,,,, $369.94 , $369.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Picc Line Insertion,,,,," $2,855.64 "," $2,855.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debride Skin Full,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debride Skin Partial,,,,, $351.92 , $351.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 , $652.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 , $620.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 "," $1,240.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulsed Lavage,,,,, $184.44 , $184.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wound Care,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitiamin D 600 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,0.9% 10ml Flush,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,1eppra 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,250ml Bolus Ns,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,A&d Ointment,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 "," $3,051.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 "," $3,244.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abreva Cream 2gm,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accuzyme Oint 30gm,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acebutolol 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen 500,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen 650mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen/Codeine,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetazolamide 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetazolamide 500mg,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acyclovir 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acyclovir 500mg Inj,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acyclovir Oint 5gm,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acyclovir Susp 200mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adenosine  6mg Syri,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aggrenox 25/200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albumin 25gm 100ml,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albumin 25gm Vl,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 0.083% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol Inhaler 8,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 , $745.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allegra D 24hr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allopurinol 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alosetron 1mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alphagan 0.2% Drops,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alteplase Vl 1mg,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amikacin 500mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 , $374.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 "," $1,026.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin 1gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin 2gm Inj,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 "," $1,176.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anucort-Hc 25mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aquacel  With Transparent Film,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aquaphor Oint 3oz,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 "," $2,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 , $585.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aspirin 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atenolol 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atropine 0.4mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atropine 1mg Syringe,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Augementin Xr 875mg,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aveeno Bath,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacitracin Oint,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 "," $1,595.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Beer 12oz Can,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benicar 40/12.5mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benzocaine (Oragel),,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Black Widow Antiveni Vl,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 "," $3,169.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bss Irr Soln Sol,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 , $508.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Tab : 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Captopril Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 "," $4,211.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carmex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 "," $2,205.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celestone Mdv : 6mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cetaphil Mois Lot,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 , $314.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Charcoal Liquid  25gm,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cipro 500mg Tablet,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Citrical D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 , $169.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 , $245.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 , $308.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Combigan Liquid 5ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Combivir Tablet,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Copaxone 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coumadin 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coumadin 7.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 "," $7,094.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 "," $1,566.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D10 W,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D50w 50ml Injection,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 , $452.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Danazol Cap : 200mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dapsone 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 "," $1,214.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 "," $1,057.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 "," $1,850.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 "," $1,451.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 "," $5,808.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 , $727.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 "," $1,162.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Destroxe 70% 500ml,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 10% 1000mls,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 20% 500ml,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 5% 100ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose Amp : 0.1,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 , $227.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 "," $1,568.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilacor Xr 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem 180,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dipentum Cap : 250mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 , $215.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 "," $8,438.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 "," $2,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 "," $6,604.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 "," $1,651.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 , $954.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 , $446.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 , $178.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 , $357.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ephedrine 50mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epidrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 "," $1,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 "," $1,591.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 , $921.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 , $776.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epogen 1000 Units,,,,, $904.00 , $904.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 , $614.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 "," $3,354.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 "," $1,225.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 , $512.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 "," $1,602.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythromycin 500mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 "," $1,201.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estrogens Esterified (Menest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Etodolac Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Etoposide Vl : 10mg,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 "," $1,195.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 "," $1,113.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 , $280.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrex 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flanders Butt Oin,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fleet Prep Kit #3,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 , $130.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 , $426.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 , $148.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 , $394.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 , $653.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 "," $1,015.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folic Acid 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide Xl 10mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucagon 1mg Inj,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucosamine 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Gel,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucovance 5/500,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycerin Adult Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycerin Pediatric Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycerin Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 "," $7,368.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 "," $1,020.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guiatuss Dac Syr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Halothane Liquid 250ml,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heparin Antibody,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 , $391.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 , $584.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 "," $1,681.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Icy Hot Cream Cream :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 "," $3,165.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indomethacin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 "," $3,652.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Glargine (Lantus),,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intralipids 20% 100ml,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 , $492.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 "," $1,797.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isentress 400mg Tablet,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Dinitrate,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 "," $1,273.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketamine 100mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lantus 100 Units/ML,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 "," $1,045.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levemir 100 Units/ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lice Comb Ea,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lindane Shampoo 60ml,,,,, $681.00 , $681.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 , $622.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 "," $2,385.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorcet 10/650,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorcet Plus,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 5,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 , $272.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 "," $1,213.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maalox,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magic Mouthwash,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Citrate 8oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Marinol 2.5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maxzide 50/75,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meclizine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace 400mg/10ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Melatonin 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Melatonin 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mepilex,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 , $838.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Merrem 250mg Ivpb,,,,, $690.00 , $690.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methadone 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methimazole Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metronidazole 500mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 "," $1,192.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 , $234.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miochol E Sol : 0.01,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mivacurium Inj 2mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mvp,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mysoline 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nabumetone 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nacl .9% 250ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nadolol 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naprosyn 500mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 "," $3,134.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 "," $1,073.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 "," $2,090.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 , $510.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norcuron,,,,, $886.00 , $886.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 "," $2,522.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin R 100 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolog,,,,," $2,822.00 "," $2,822.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns 1000ml Bag,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns 100ml Bag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns 250ml Adv Bag,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns 250ml Bag,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns 50ml Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns Irrigation 3000ml,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns Plus 100ml Bag,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns Plus 50ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Cream 15gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 , $449.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 "," $1,599.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 "," $1,524.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peg Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 "," $8,933.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 "," $1,999.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pentasa 250mg Capsule,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Petrolatum White Oin,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pindolol Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 , $435.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polycitra Lc Sol,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Premarin 0.625 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prenatal Vitamin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Preparation H Ointment,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Progesterone Microni (Prometri,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 "," $1,389.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protamine 50mg Amp,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 , $409.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinine 325mg Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 , $751.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 , $732.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Refresh Tears 15ml,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renagel 800mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 "," $1,694.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 , $575.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rifampin 300mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 1mg/1ml,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 , $775.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rocaltrol .25mcg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Salsalate Tab : 750mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Silver Nitrate Stick,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 "," $1,455.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 , $275.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 "," $1,622.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sorbitol 70% 30ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 , $484.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Starlix 120mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Water 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Streptomycin 1gm Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 , $288.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulindac Tab : 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulindac Tab : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Surgilube Oin : 60gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Symmetrel 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Symmetrel Syr 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 0.05mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tekturna 150mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 "," $7,624.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 , $344.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 , $685.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetracycline 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 , $560.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thrombin 5000 Unit,,,,, $937.00 , $937.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid Tab : 1grain,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 , $377.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 , $617.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin 300mg Inh,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin 80mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 , $322.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 , $419.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 "," $5,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trace Elements 5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trental 400mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 , $694.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tricor 48mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urogesic Blue Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 "," $1,023.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin 1gm Vl,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin 500mg Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vasopressin Vl : 20units,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vecuronium 10mg Inj,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil 240 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil Tab : 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vfend 200mg Tablet,,,,, $764.00 , $764.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 "," $2,499.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Viread 300mg Tablet,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vistaril 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin A 10mu Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $702.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc 10mg Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc 220mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc Oxide Ont,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $402.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 "," $1,332.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $595.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accucheck,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,A/B Otic Drops,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 15 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 30 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 5 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acarbose 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accolate 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accupril 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acidophillus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aciphex 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Actonel 35 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Actos 15 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Actos 30 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Actos 45mg,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advair,,,,, $408.00 , $408.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advair Discus 250/50,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advair Diskus Inh,,,,, $819.00 , $819.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advanced Eye Relief,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advil 200mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aerobid,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aerochamber,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aggremox Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aggrenox ER Caps,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Akwa Tears,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aldactone 25mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alendronate 35mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alendronate 70 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aleve,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Align,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allegra 180 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allegra 600 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allegra-D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Altace 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Altace 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amaryl 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amaryl 4 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ambien 10mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ambien 5mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ambilify 10 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amblify 15 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlopidine-Benaz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anafranil 25 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Analgestic Creme Rub,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anaspaz Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antacid Susp Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antioxidant Vitamins,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anusol Hc Supp,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arimidex 1 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Asacol 400 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ascensia Elite #50,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Asmanex Twisthaler,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aspercreme 10%,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Asprin 81mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atacand 16 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atacand 32 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atarex 25mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atenolol 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atenolol 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ativan 1mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ativan 2mg/ML,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atrovent Inhalation,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atrovent Inhaler,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avandia 2mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avandia 4mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avapro 150mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avelox 400mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azo Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,B-1,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Baclofen 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bactrim Ds,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $401.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benadryl 25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benadryl 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benicar 20mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benicar 40 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benicar 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztrop 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztropine 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betapace 80 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bethameth Driprop .5,,,,, $499.00 , $499.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bethanechol 50mg,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biaxin 500 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisacodyl 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biscolax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisoprolol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Black Cohosh,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blistex Lip Medex,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Boniva Tab 150,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Boost,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bumex 1mg,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspar 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspar 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspirone 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspirone 15 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspirone 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspirone 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bystolic 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calan 120 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calan Sr 180mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium 600+d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Carbonate 60,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Caltrate 600 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Campral 333 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Capoten 25mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Captopril 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Captoril 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazepine 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazepine 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardina 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardura 2 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cecon Bottle,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftin 250mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celebrex 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celebrex 200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celexa 20 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cellcept 250mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Centrum Silver Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Century 50 Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Century Senior Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cepacol Lozenges,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlestyramine Packet,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chloraseptic Spray,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorex-A Tablets,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorophyll 3mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorpromazine HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholestyramine Packs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Citalopram 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Citalopram 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Citalopram 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clarinex 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Claritin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cleocin 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clobenzaprine HCL,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine .2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrim Antifungal,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clozaril 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cogentin 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cogentin1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Col-Benemid,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Combigan Eye Drops,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Compazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Compound Rx 30gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Comtan 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Copaxone 20mg,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cordarone 200mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Corgard 40mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Corge 12.5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Corona Ointment,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Correc Cr 40mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cosopt Eye Drops,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coumadin 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cozaar 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cozaar 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cozaar 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crestor 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cymbalta 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cymbalta 30mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytra K 5ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darvocet N 100mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darvon 65mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depo Provera,,,,, $729.00 , $729.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desipramine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desyrel 100mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Detrol La 4 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diabeta 5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diclofenac Sod,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diflucan 150 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin 250mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin 50mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem ER 120,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan 160 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphedryl Sod,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divan 40mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Docusate Calcium,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Donnatel/Maalox,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxazosin Mesylate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxycycline 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dss 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dss W/Casan,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dulcolax,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duoneb 2.5,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dyazide,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dynapen 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dytan 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Effexor Xr 150mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Effient 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elavil 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $235.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elnorm 6mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril Maleate,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 "," $1,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Esidrix 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eskalith Cr,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estazolam 1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estropipate 0.625,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Etodolac 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,E-Vista 60 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Evoxac 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exelon 3mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exelon 6 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exforge 5 320mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eye Stream 30ml,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Famotidine 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Felodipine ER 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Femera 25mg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feosol,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fergon,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fexofenadine HCL,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fiber Laxative 625,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fiber Powder,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fibercon 500mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fibercon 625 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Finasteride 5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fioricet 1 Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flagyl 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flonase Nasal Spray,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $230.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flu Vaccine,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fludrocortisone Ace,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoprazine 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flurazepam,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluticasone 50mcg,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluzone,,,,, $237.00 , $237.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folamin Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foltx Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fortical Nasal Spray,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fosamax 70 Mg,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fosinopril/Hctz,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabitril 12mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Genasyme 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Genebs 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Genteal Drops,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 20 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $654.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 80 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geritol Complete,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucophage 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucotrol 5mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucovance 2.5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycolax 255 Gram,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glynase 3mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guanfucine 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 5 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 5mg/ML,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol ML 120,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hcts 1% 30gm,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humalog Ins Inj,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humulin 70/30,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrea 500 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hypotears Eye Drops,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hytrin,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,I Caps Plus,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Imdur 30 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immitrex 50 Mg,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immodium 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inderal 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inderal 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inderal La 120 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inspra 25 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Humulin R,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Invega 3 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isopto Tears,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isordil 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Nacl,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Januvia 50 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Jevity 1.5,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Juven,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K Dur 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keflex 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keflex 500mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kenalog,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $461.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keppra 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Klonopin 1 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Konsyl Powder,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Labetalol HCL,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactaid Fast Act,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamictal 100mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamictal 150mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamictal 25mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lantus Insulin 100,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lantus Insulin Inj,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Latuda 40 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Laxative Suppository,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lecithin 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lescol 20 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lescol Xl 80mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levaquin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levaquin 500mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levemir Vl,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothroid .05 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothroid 0.125,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothroid 75mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroid 25mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levthyroxine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lexapro 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lexapro 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Limbrel 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lioresal 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipitor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipitor 20 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipitor 40mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lodine 500 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lofibra,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lomox Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loniten 2.5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loperamide Hci Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lopid 600 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lopressor 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loratadine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab-5,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotensin 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovastatin 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovaza 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovenox 40mg,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loxitane 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lumigan Eye Drops,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lunesta 1 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lunesta 2 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lunesta 3 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lyrica 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lyrica 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lyrica 300 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maalox 0,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Macrobid 100mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mag Ox 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Citrate,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Oxide 241,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mavik 1 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maxzide 75/50,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medrol Dose Pak,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Susp. 5ml,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mephyton 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metaformin 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metamucil Pkt,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin 1000 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin 850 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin HCL 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methadone HCL 10mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methotrexate 25mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoclopramide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoclopramide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metolazone 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Succ,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mevacor 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miacalin 200u Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mi-Acid Gas,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Micardis 40 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Migrazone Capsules,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Minocin 100mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miralax Packet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miralex 255 Gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Moban 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Moban 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Monopril 20mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Motrin 120ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Motrin 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Motrin Susp 5ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucinex 600 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multigen Plus Caplet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multivitamin With Mineral,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Murine Tears Plus,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mylicon 80,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nadolol 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Namenda 10mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Namenda 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naphcon-A 5ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen 250 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen 500 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen Sod,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasacort Aq,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasal Solutions,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $557.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nature Tear Drops,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Navane 5 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nb Valerian Root,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neosporin Ung Pk,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neurontin 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neurontin 300 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nexium 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nexium 40 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Niacin 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nifedipine 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Niferex 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nilandon 150 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroquick,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norco 10/325 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norpramin 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norvasac 5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norvasc 10mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin 70/30,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin R 100 Units,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolog Mix 70/30,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Occuvite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Omacor 1 Gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Omnicef 300mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,One A Day,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,One-A-Day Mens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Opana ER 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orajel,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orap 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Os Cal 500d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Osteo Bi Flex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxytrol Patch,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oyster Shell Calcium,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pancrease Ec Caps,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil 20 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil Cr 12.5,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pepcid  Complete,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Periactin 4 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peridex 473ml Sol,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perparation-H Ointment,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perphenazine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan Supp,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytek 300mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pindolol 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plaquenil 200mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plavix 75mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pletac 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pletal 100mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potass Cl Meq,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravachol 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravachol 20 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravachol 40 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Precose 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisolone Acetate,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prelone 5mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Premarin Vag Cream,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Preservision Softgel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prevacid 15mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prevacid 30mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prevastatin Sod,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prisolec Otc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pristiq 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 "," $1,002.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 "," $1,815.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine Supp,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proscar 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prostate Formula,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protocream Hc 30gm,,,,, $440.00 , $440.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protonix 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protonix 40mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Provera 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Provigil 200 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prozac 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prozac 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyridoxine 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Questran Pckt 9g,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinapril 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinapril 20mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinapril 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinidine 200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ramipril 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rampipril 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranexa 500 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rapamune 1 Mg,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Razadyne 12 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Razadyne 8 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Refresh Eye Drops,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Relafen 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Remeron 15 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Remeron 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Remifemin Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reminyl 12mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip .25 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip 1mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Restoril 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rezadyne 4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rhinocort Agua,,,,, $378.00 , $378.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $932.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 1mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 2 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 4 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $946.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperidone .25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperidone .5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperidone 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperidone 4 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ritalan 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Robitussin 5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Robitussin Dm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole .25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole HCL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rozerem 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Saphris 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Saphris 5 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senna Gen Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senna Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sennalax-S Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senokot 187mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Septra Ds,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Serevent Disl Inh,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroguel 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 300 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Serzone 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shopax 100 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinemet 25/100,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinemet 25/250,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Singulair 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skelaxin 800mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slow Fe 160mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slow K-8 Meq,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sonata 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sonata 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spiriva 18mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spiriva Handihaler,,,,, $429.00 , $429.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spiriva Refill,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $660.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ssystane Eye Drops,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ST John's Wart,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Starttera 40 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stool Softner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Strattera 25 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stress W/Zinc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sumatriptan Succ,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Super Thera Vite Mt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Symbicort 80 4.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Symbyax 6/25mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Symmetrel 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid .05 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid .2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tamoxifen 10mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tapazole 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tarka 2/240,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tears Pure,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegretol 200mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tekurna 150 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Temazepam 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Temazepam 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tenex 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tenormin 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tenormin 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terazosin,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terazosin 5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terbinafine HCL 250,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theo-24 200 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theo-Dur 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theophylline 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theragran M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Therapeutic M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thermotab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiamin 50 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiamine 100 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid 2 Gr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tofranil 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tofranil 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topamax 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topiramate 100 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toprol Xl,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Torsemide 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Torsemide 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Traqzadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazadone 150 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tricor 145mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trileptal 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trilipix 45 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trimpex 100 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tums 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tussin Cough 8oz,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uloric 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ultracet 37.5/325,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ultram 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uniphyl 400mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Univasc 15mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urecholine 25mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uroxatral 10mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vantin 200 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vasotec 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vasotec 5mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil 180 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vesicare 5mg,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Viactiv Chew Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vicon C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vigamox Drops,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Visken 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin A,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B-1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D 400 U,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Volaren 1% Gel,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Voltaren 75mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Water 45 M,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Welchol 625 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Women's One A Day,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xarelto 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Z0cor 20mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zanaflex 4mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zantac 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zelform 6 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zestril 10 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zestril 20mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zestril 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zetia 10 Mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ziac 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc 50mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc Gluconate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zithromax 250 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zocor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zocor 40mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zocor 80 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zofran 4mg Tab,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zoloft 100 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zoloft 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zoloft 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zolpidem Tartrate,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zonegran 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zonisamide 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zovirax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyloprim 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyloprim 300mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 15mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexia 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyrtec 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 2 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acamprosate Calc 333,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accupril 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accupril 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accupril 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accuzyme Oint,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $559.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $632.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adderall 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adderall 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advair Diskus 100/50,,,,," $1,128.00 "," $1,128.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advair Diskus 500/50,,,,," $1,855.00 "," $1,855.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advair Hfa 115/21,,,,," $1,391.00 "," $1,391.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advil Congest Rel,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Advil Pm,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Afrin  .05 Spr,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alaway Eye Drops,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 2mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol Inhaler,,,,, $293.00 , $293.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aldactone 50 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alendronate 35 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aleve 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allegra 60 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allopurinol 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $460.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Altace 1.25 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Altace 10 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amaryl 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $613.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amikacin 500 Inj,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlactin Lotion,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amloride 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin 500mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anikacin Inj 250,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apresoline 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 "," $1,656.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arava 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aripiprazole 15mg,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Armour 90 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aromasine 25 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Artificial Tears,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $742.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aspercreme,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Astelin Nasal Spray,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atacand 8g,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atenolol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ativan 0.5 Im,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 "," $1,242.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $711.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Augmentin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avandia 8 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $733.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ayr Nasal Mist,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azilect 1 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azmacort,,,,, $607.00 , $607.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azopt Drp 1%,,,,, $482.00 , $482.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Azor 5/40 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacid Capsules,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Baclofen 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Baclofen 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Baclofen 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacmin Tab 1,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $680.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bee Pollen,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benadryl Crm 2%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benicar 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benztropine 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betamethasone Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betoptic S Ophth,,,,, $480.00 , $480.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 "," $1,129.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biotene Mouthwash,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisacodyl 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brimonidine 0.2%,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brintellix 10 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 "," $1,086.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bystolic 10 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bystolic 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calan 80 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcarb 600 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitrate 600 + D,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Carb 600mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calmoseptine Pks,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Caltrate 600 Plus,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardizem 30 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardizem 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardura 1 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardura 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carmex Lip Ointment,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Casodex 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefpodoxine 200,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftin 500 Mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cefzil 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celestone 2 ML Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celexa 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celexa 15 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celexa 40 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cellurisc 1%,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Century Senior Vitamin,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Century Vite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cepacol Throat Spray,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cephalexin Monohydra,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cerefolin,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cerefolin Nac,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cetaphil 80z,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chantix .5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chantix 1 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholestyramine Powder,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chromagen Forte,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chromium 200 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $683.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Citracal Petites,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Citrucel Each Scoop,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clarithromycin 500mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Claritin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin Oint,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $385.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine 0.1,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $447.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $349.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole 1%,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clozapine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clozaril 100 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clozaril 50 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clozipine 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clozipine 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cogentin 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colace 100mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colace 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colcrys .6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colon Clenz Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $621.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Combivent Respimat Inh,,,,," $1,335.00 "," $1,335.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Complex + Msm,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coq-10 200 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coreg 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coreg 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coreg 40 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cortef 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $436.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coumadin 6 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Creon Dr 3000 U,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crestor 20 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crestor 40 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crestor 5 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytomel 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dantrolene Sodium,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Decadron 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Delsym Each Tsp,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote 1000 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote 1500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote 750 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Deplin 15 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desipramine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desloratadine 5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Desonide Lot 0.05,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexilant 30 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dexilant 60 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dextrose 50% Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diamox 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diary Digest,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diatx Tab 1,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diflucan 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diflucan 200 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin 0.1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin 0.25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $243.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin 200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin 400 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan 320 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diovan 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ditropan 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ditropan 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Docusate Calcium 240,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $121.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin 75 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duleek Met,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dulera Inhaler,,,,," $1,241.00 "," $1,241.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duoneb 3ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ear Wax Drps,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Effexor 225 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Effexor 50 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elavil 100 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $506.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elimite Cream 5%,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eliquis 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elmiron 100,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enablex 15mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril Maleate 10,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enoxaparin 100mg,,,,, $583.00 , $583.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Entacapone 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Entacort .25 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epoetin Alfa,,,,," $4,247.00 "," $4,247.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estroven Weight Mgt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Etodolac 100mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Etodolac 400 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ex-Lax,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fanapt 1 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fanapt 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fanapt 4 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Felcainide 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feldene 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Felodipine 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fenofibrate 145mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feogen Ga,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fergon 27 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fergon 324 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flagyl 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flecainide 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flector 1.3% Patch,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flexeril 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flexeril 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Florajen Acidophilus,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Floranex Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Florastor 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flovent Hfa,,,,," $1,507.00 "," $1,507.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $625.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folacin B/6/B12,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folbee Vitiamn,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folbic,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foltanx 90 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foltrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $284.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Freshkote Eye Drps,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Furosemide 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fycompa 8 Mg,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabitril 16 Mg,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabitril 6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabitril 8 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gas X 180 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gaviscon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 10 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 10mg Injection,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 30 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glcagon Inj,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide 15 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glipizide 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucophage 250 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Tablets,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide 3 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gs Century Vits,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $58.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gynalotrimin,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hematogen Capsule,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemocyte Plus,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hum Benzoin Compound,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocort 2.5%,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $684.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,I Car-C Plus Sr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,I Vite,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Icaps M/V (Eye),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Imdur 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Imipramine 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inderal 25 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indocin 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indomethacin 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insta Glucose Gel,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Instaflex Joint Support,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Integra Vit,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 "," $2,076.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Invokana 100 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Jantoven 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Januvia 100 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Januvia 25 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,J-Tan D Sr,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K Clor 8 Meq,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K Dur 20 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K Dur 30 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K Dur 40 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K Phos,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 10 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kcl 8 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keppra 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keppra 750 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Klonopin 2 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Klor Con 10 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Klor Con 20 Meq,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Labetalol 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Labetalol 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lacrilube Oint,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactaid,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactinex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactulose 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamictal 200 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $171.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamisil,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamisil 250 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamotrigine 25mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lanacane Compound Oint,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Latuda 20 Mg,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Latuda 80 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $972.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levaquin 750 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levemir Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levemir Flexpen,,,,," $1,510.00 "," $1,510.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothroid .15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothryoxine 88mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lexapro 15 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lexapro 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lexapro 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Librium 5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipitor 80 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium Carbonate 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Livalo 2 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lodrane D24,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loperamide 2 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lopressor 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lopressor 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 2.5/500,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Losartan 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Losartan 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Losartan 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotemax Opth 5%,,,,, $657.00 , $657.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotensin 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotensin 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotensin 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loteprednol Drop,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovaza Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loxapine 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loxapine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $692.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lyrica 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lyrica 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lyrica 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maalox 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medical Food 1 Tab,,,,, $188.00 , $188.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace 60 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 "," $3,406.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megestrol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Melatonin .75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Melatonin 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Memantine HCL 10mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mestinon 60mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metafolbic Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metalozone 5 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metamucil Cap,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metanx 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin 250 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin 600mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methadone 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methadone 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metronidazole 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 "," $1,011.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Micardis 80 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midodrine 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Midrin Capsules,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Minipress 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Minocycline 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirapex 1 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mobic 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Modafinil 200 Mg,,,,, $47.00 , $47.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Monopril 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Montelukast 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine 15 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucinex D,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multaq 400 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multivitimine,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mylanta 15ml,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mylanta 30 Cc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mylanta Bottle,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mylicon 125 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nalfon 400 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naprelan 375 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen 375 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen 550 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Narco 10/325,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Narco 5/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasal Crom Spray,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nauzene,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neosporin,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neurontin 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neurontin 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neurontin 800mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neurontin 900 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neutro Phos 250mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Niacin 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine Transdermal,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nisoldipine 20mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitrolingual Spray,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norco 5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norflex 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin 100units,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolog Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Novolog Flexpen,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuedexta 20/10,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $319.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ocean Mist,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ocean Nasal Spray,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ointment 120 Com,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 5mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Omeprazole 10mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Onfi 10 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Onglyza 5 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Opcon A Eye Drops,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Optive Eye Drops,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Os Cal 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Osphena 60 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone 5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paceron 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paceron 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pamelor 50 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pamelor 75 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pancrelipase 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pangestyme Ec,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pataday Eye Drops,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Patanase Nasal Spray,,,,, $535.00 , $535.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Patanol,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $774.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paxil 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pentazocine Nalox,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pepcid 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pepcid 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Percocet 3.75/250,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Percocet 5/325,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peri Colace,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Periactin 2 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phazyme 180 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenergan W Codine,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital 60mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phentermine 37.5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pioglitazone 30mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pioglitazone 45mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plagic 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plavix 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plendil 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plendil 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ployethylene Glycol,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pneumonia Vaccine,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Ch 10meq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Phos 250,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prandin 1 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravachol 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prazosin 1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prazosin 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prazosin 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 30 ML,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prednisone 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pregabalin 25mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pregabalin 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Premarin .9 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Premarin 0.3,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Premarin Cream 30g,,,,, $978.00 , $978.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Preparation H Supposority Box,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Preservision Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prevalite Powder,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prilosec 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Primidone 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Primidone 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pristiq 100 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proamatine 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proamatine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Probenecid Colchicicine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 "," $1,277.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $725.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $274.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prograf 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prometrium 100 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promod 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol 80 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prosight,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prostat 30 Cc,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Provera 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Provigil 100 Mg,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prozac 40 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $432.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prozosin 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Psyllium See Pack,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $656.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulmocare Nutrition,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyridium 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Qnasl Nas Spray,,,,, $700.00 , $700.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Questran 2 Gm,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Questran 9gm Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinidex 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Qvar Inhal,,,,, $825.00 , $825.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ramipril 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Refresh Pm Ointment,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 "," $4,243.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Remeron 45 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renvela 800 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip .125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip 0.5mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip 4 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Resperdol 1 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Restasis 0.5%,,,,, $815.00 , $815.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Restoril 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rifampin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risamine Oint,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $257.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal 6 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $766.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 "," $1,716.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 "," $2,250.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 "," $3,147.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperidone 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Risperidone 3 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ritalin 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ritalin 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ritalin 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rivastigmine 3mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Robaxin 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Saline Flush,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sam E 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sam E 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sanctura 20mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Santyl Top,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Savella 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Selenium Shampoo,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senna 8.6mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sensipar 30 Mg,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Serax 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 500 Mg,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel 75 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sertraline 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sertraline 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Silenor 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Silvadene Cream,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Silversulfadiazine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simethicone 80 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinemet 12.5/50,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinex Nose Spray,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Singulair 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sotalol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sotalol 80mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spiriva Inhaler,,,,, $444.00 , $444.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sporanox 100 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sps Suspension 60ml,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stalevo 100 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stalevo 150 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stalevo 50 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stalevo 75 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Starlix 60 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stelazine 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stelazine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $134.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sudafed 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sudafed 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sular 17 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sular 34 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sumatriptan 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sumatriptan 25mg,,,,, $427.00 , $427.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Surmontil 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 "," $1,384.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 "," $1,029.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tagamet 400 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tamiflu,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tapazole 10 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tapazole 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tarvatan Drops,,,,, $514.00 , $514.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tavist,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegretol 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegretol 300 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegretol 400 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tekturna 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tenex 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terazosin 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theophylline 400 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theraseal Hand Cream,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tiagabine 4mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ticlid 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tigan 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tinactin Spray,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobradex Eye Oint,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobradex Opth Drops,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $451.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topamax 200 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topamax 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topiramate  25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topiramate 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toradol 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toviaz 8 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trandate 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Travoprost Eye Drops,,,,, $538.00 , $538.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone 25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tricor 48 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trilafon 8 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trileptal 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trileptal 400 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trileptal 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trileptal 75 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trilipix 135 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trospium 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tums 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tums 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tums 650 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Turmeric Curcumin,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol 325 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol 650 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol Pm,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ultracet 100,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urecholine 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urelle Tablet,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uricholine 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urimar-T Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ursodiol 300mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valisone,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valium 5 Mg Im,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid 125mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid 500mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valsartan 160,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valsartan 320 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valsartan 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valtrex 500 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $238.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil 80 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vesicare 10mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Viamin B Complex Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Viamint E 200iud,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Victoza Epipen,,,,, $821.00 , $821.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Victoza Pen Bx,,,,," $2,143.00 "," $2,143.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Viibryd 40 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vimpat 100 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vimpat 200 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vimpat 50 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Visine Eye Drops,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vistaril 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B3 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Vitamin D 50,000",,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vivactil 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vivactil 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Voltaren 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Whey Protein Isolate,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xarelto 15 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xarelto 20 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $276.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xopenex Inhaler,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Z-Gen,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zioptan Eye Drops,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zithromax 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zocor 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zofran 8 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zoloft 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zoloft 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zolpidem Cr 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $982.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zpak 250 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyrtec 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zyvox 600 Mg,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Torsemide 5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Candesartan 8 MG,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orap 1 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $197.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Norvasc 5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CEROVITE SR TABS,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BUPROPION 75 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,venlafaxine 25 mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 "," $1,474.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VYVANSE 50 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $362.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $631.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 "," $1,062.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 "," $1,405.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $3.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $728.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ULORIC 80 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CREON 12000 U,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BRILINTA 90 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FUSION PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FOLBEE PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 "," $1,194.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LINZESS 145 MCG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LATUDA 60 MG,,,,, $144.00 , $144.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,INVOKANA 300 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VIMPAT 150 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DILANTIN 30 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PREPARATION H SUPP,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,REXULTI 1 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FARXIGA 10 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,REXULTI 2 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MELATONIN 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $816.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FETZIMA 40 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FETZIMA 80 MG,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NAPCON A SOL,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MELATONIN 0.5,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $787.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LIVALO 4 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 "," $1,538.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $193.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 "," $1,766.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $199.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FE C TAB 100,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mybetriq 25 mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $1.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $2.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $79.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AZOR 10/40 MG,,,,, $49.76 , $49.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LABETALOL 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 "," $2,517.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CREON 6000 U,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,REXULTI 3 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $20.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 "," $1,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $3.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $3.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $52.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $6.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $34.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $68.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ATRIPLA,,,,, $399.80 , $399.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $13.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $1.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $1.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $3.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $59.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $818.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $61.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $1.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $4.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $131.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $51.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $3.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $445.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $2.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arginaid Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $525.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 "," $1,992.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coban,,,,, $10.32 , $10.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Descovy 200 25 mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $291.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estroven 1 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lamicatal 200 mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lisinopril 15 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $51.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $33.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $7.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metoprolol 100 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $165.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebivolol 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pataday 2% (bottle),,,,, $594.00 , $594.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pataday 2% (drop),,,,, $19.80 , $19.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $3.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $11.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Primidone 150mg,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Propranolol 20mg,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Requip 3mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Salagen 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tivicay 50 mg,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toprol 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Torsemide 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tresiba (unit),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Warfarin 40mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zocor 20mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zocor 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zoloft 200mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zonisamide 75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Naproxen 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinemet 50/200mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $63.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $3.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $540.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tandem Plus Capsule,,,,, $6.96 , $6.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $28.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $2.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LATUDA 10 MG,,,,, $99.91 , $99.91 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MULTILEX,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $202.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $195.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $13.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $7.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $31.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $26.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $9.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $188.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $1.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LINZESS 290 MCG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $2.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $113.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $2.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $37.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $21.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $5.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $14.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $257.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $56.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $55.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $23.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $43.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $17.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 "," $1,548.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pentasa 500 MG,,,,, $29.32 , $29.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CENTRATEX,,,,, $4.48 , $4.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $11.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $5.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $9.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $55.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,REXULTI 4 MG,,,,, $184.68 , $184.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $8.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $148.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $2.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $58.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $8.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $6.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $172.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,SALSALATE 500MG,,,,, $71.22 , $71.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $100.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $34.17 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $48.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $81.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $15.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuplazid 34 mg,,,,, $304.74 , $304.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 "," $1,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $8.29 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $122.61 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Infusion Therapy,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 "," $2,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $421.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $844.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $231.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,10ml Control Syringe,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,14fr Stylet Slip,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,21 Lnr Ps,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $189.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,300cc Collection Canister,,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,48  Press Moniter Line,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adapter T,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Air Hose Disposable,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Air Hose Reusable,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alcohol Prep Pads,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Algidex Ag Gauze,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Reflux Filter,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antifungal Cream,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antireflux Filter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bacteria Filter,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Scissors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $38.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Surepress Compression,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Barrier Film,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bed Air 48,,,,, $119.78 , $119.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bed Air 48  Turning,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betadine Sol 8oz,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Betadine Swabsticks,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bite Block,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $359.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bottle 100ml Saline,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bp Cuffs Medium,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bracket  Mounting,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Bridge,suture Retention",,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brief Adult Large,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bucks Traction Boot,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calazime With Olivamine,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cannula Etc02,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Cap, Trach",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carafe With Straw,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $57.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter Connector,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter Connector (Blue),,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter IV,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter Stabilization Device,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Centerpointlock Pouch,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 "," $1,068.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Tube Tray,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Clamp, Beta",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Clamp, Occluding",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Cold Pack, Instant",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $27.15 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Commode Containers,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cone Finger Separater,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cooling Blanket,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Cover, Probe",,,,, $76.32 , $76.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $259.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cup Medicine,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debridement Tray Gss,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Del Clamp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digital Termometer,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dispo-A-Probe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Disposable Headstrap,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Disposable Lead Wires,,,,, $261.82 , $261.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drain Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $58.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dycem Matting,,,,," $1,064.24 "," $1,064.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Edema Gloves 1ea,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Expiratory Filter,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 "," $2,764.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flexiseal Bag,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flexiseal Management System,,,,," $2,640.46 "," $2,640.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $10.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Forceps, Adson",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Full Face Mask Large,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Full Face Mask Medium,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Full Face Mask Small,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gair Built Blue,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $323.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Geri Chair Cushion,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gloves Large Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gloves Medium Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucerna 1.2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hair Brush,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Pitt Padded,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemostat Absorbable,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,High Flow Humidification Syste,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hip Kit,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hot Packs,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrogen Peroxide,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $135.21 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ioban Steri Drape,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Start Kit,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kerlix Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kit Suture Removal,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $157.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $220.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 "," $1,022.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee Support Brace,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Label IV Day of Week,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $97.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Large Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liquid Skin Protectant,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lotion Hand/Body,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $103.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Male External Cath-Medline,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask, Ear Loop",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask, Full Face Large",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask, Full Face Small",,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask, Nasal Small",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Med Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meplix Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Odor Eliminator Scented,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oral Care Kit,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Pack, Basic",,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Palm Cups 60mm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Palm Grip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Passy Muir Valve,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Petroleum Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pneumothorax Set,,,,," $1,244.44 "," $1,244.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Port Protector,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $118.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 "," $1,866.07 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 "," $2,014.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pressure Port for Therapep,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $101.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Razors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reacher 32,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ready-Bath,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rectal Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $596.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Set Catheter Irrigation,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoe Horn Long 24,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoulder Immobilizer,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shower Caps,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skin Closure Strips,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $42.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Soap Deodorant,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Speicmen Collection Commode,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spenco Boot--Outer,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Saline 100ml,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Sheets,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Water 1000ml,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suction Canister 1200cc,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suction Canister 2400ml,,,,, $34.98 , $34.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 "," $1,417.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suture Removal Kit,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 20cc Ll,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Syringe, Insulin",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tape Durapore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tape Measure,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tape Micropore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tape Transpore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tape Transpore 2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $186.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theraband Green,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Therapep,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theraputty Red,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theraputty Yellow,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thick & Easy,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thigh Garment Scd,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tongue Blade,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trac Y Connector,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $44.37 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Tray, Percutaneous",,,,, $629.64 , $629.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tubing Corrugated,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $18.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinal Female Guardian,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinal Male Supreme,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vac Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vent Circuit,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vest Starter Kit,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Viscopaste Pb7,,,,, $109.18 , $109.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitalstim Therapy,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Water Pitcher 22oz,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wedgesx2,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Weighted Bendable Fork,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wing Infusion 22inch,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Winged Infusion 20in,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $239.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adult Wipes,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alcohol Preps,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alldress Dressing,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Catheter,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arm Sling,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Baby Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandaid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Briefs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Comb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Connecting Tube,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Denture Adhesive,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Denture Cup,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Deodorant,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dressing Change Charge,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duoderm Dressing,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,E Cylinders,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enema Bag With Soap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ensure,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Extension Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feeding Set,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fleets Enema,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucerna,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Strip,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Graduated Container,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gt Bag,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hair and Body Shampoo,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heel Protectors,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hibiclens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Hose, Care Knee",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Introcan 22g 1 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kerlix,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kleenex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lancet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lice Treatment,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lip Balm,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Messengile Douche,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mouthwash,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nail File,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasal Cannula,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebulizer,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,No Rinse Shampoo,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,O2 Concentrator,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perineal Cleaner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Posie Pads,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Q-Tips,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shave Cream,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skin Prep Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Slipper Socks,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Soap Bar,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Speci-Hat,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Specimen Container (Sterile),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Staple Remover Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe With Needle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Telfa Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thick It,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toothbrush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toothette,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toothpaste,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tubing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Underpads,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinal,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vaseline,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vial Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vista Pump,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vista Pump Set,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wash Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Water Pitcher,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wound Cleaner,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wound Gel,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Emery Board,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Emesis Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,2 3/4  Wafer,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"4"" Kerlick",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"4""drainable Pouch",,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ace Bandage,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adult Pullups Large,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adult Pullups Medium,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adult Pullups Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bed Pan,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ben Gay,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Briefs Extra Large,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Briefs Large,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Briefs Medium,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Briefs Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Butterfly Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Autoguard 20,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Catheter, Condom",,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Catheter, Foley",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clean Catch Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colostomy Pouch,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Denture Brush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ensure Shake,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enteral Feeding Kit,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $822.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heel Suspension Boot,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Horizon Tubing,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hoyer Lift Pad,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydrogel Dressing,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ileostomy Bag,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Incentive Spirometer,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulated Water Carafe,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iodine Prep,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Pump Daily,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lubricating Jelly,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lubriderm,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medseptic Packet Each,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebulizer W/Mask,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nizoral Shampoo,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Non Adherent Pads,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ocean Spray,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Paper Tape,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Personal Belonging Bag,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Resource 8 Oz Can,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sarna Lotion,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Selson Blue Shampoo,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Speciman Cups,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Straight Catheter,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suplena 120 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 12cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 1cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 3cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 5cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ted Hose Knee High,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ted Hose Thigh High,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tinactin Powder,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Unna Boot 4""",,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vaseline Pkts,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wafer,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bariatric Bed,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Air Mattress,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trapeze Bar,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wound Vac,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bariatric Lift,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CATHETER MIDLINE,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Catheter, short term, straight",,,,," $2,543.00 "," $2,543.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blanket Bair Hugger,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,STERILE CAP MALE,,,,, $0.50 , $0.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 "," $2,713.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,B.D. Neelde,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Distilled Water,,,,, $11.19 , $11.19 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Steri Strips,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sling Arm Large,,,,, $28.18 , $28.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Collar Cervical,,,,, $84.62 , $84.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoe Post OP,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Boot Ankle Contracute,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Belt Gait 60inch,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Decannulation Plug,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $41.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abduction Wedge,,,,, $551.60 , $551.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Airway Guedel 70mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Airway Guedel 80mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $8.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Surgitube Large,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Surgitube Small,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $282.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee Immobilizer,,,,, $271.24 , $271.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $79.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $26.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $40.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $259.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $259.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $27.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $16.35 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Admission Set Up,,,,, $831.04 , $831.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cannula High Flow,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coloplast Clamps,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Control Mitt,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Isosource,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Jevity,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Juven,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Nepro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Oxepa,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Prostat,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $219.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trapeze Free Standing,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Central Line Dressing Kit,,,,, $822.48 , $822.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eclipse Injection Needle,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humid Vent 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aldosterone Bld,,,,, $938.10 , $938.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amitriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Huab,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Yob,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Benzodiazepines,,,,, $302.10 , $302.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamezipine Free,,,,, $237.44 , $237.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath for Collection,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPT Initial,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPT Subsequent,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiv-1,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lead Urine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Manual Differential,,,,, $623.28 , $623.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Microalbumin Urine,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myoglobin,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Parvo Virus Igg,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Parvo Virus Igm,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 "," $1,968.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $68.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protime,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $215.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Smear Nasal Eos,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sputum Collection,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinalysis Dipstick,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venipuncture,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,West Nile Virus Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,340 Measure Volume,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Afb Culture,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Afb Sensitivity,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ANA Titer & Pattern,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Scl 70,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antigen Type,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aso Titer,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bld Type Du,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Marrow Studies,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CBC With Auto Diff,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cell Count Csf,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlamydia by Probe,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlamydia Group Ab,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $549.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cmv Igm Ql,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crystal ID Synovial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Directogen Serum,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eosinphhil Count,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epstein Barr Ea,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epstein Barr Ebna,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epstein Barr Vca,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Era,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Febrile Agglut Each,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fecal Fat,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fibren Split Product,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fibrinogen Quan,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flow Cytometry Dna,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,H Pylori,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Handling Fee,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemo Influenza,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $348.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiv,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiv Viral Load,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiv Western Blot,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Holter Monitor 24hr,,,,, $414.00 , $414.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hpv Culture,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iep Except Serum,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iep Serum,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kell Ag Titer,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lupus Anticoagulant,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Manuel Diff,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metanephrines Urine,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Misc Immun Proc,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ob Screen,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Occult Blood,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ova Paras Smears,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pertussis Smears,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Cnt,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Count Auto,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pra,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein Electrophore,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rapid Group A Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rapid Group B Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Retic Absolute,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $397.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rocky Mountain Igg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,RPR,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,RPR Titer,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,RSV,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,SED Rate,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Semen Analysis Compl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Semen Post Vasectomy,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sickle Cell Prep,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Smear Review by Path,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urea Breath Collect,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinalysis,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinalysis Chem Only,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urine Immun Fixation,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urine Microscopic,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Varicella,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,WBC,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,West Nile Igm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wet Mount,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $546.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $701.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $719.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ova Parasites Ocp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $839.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urine 24 Hour,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urine Culture,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,WBC W Differential,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT/INR,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TPA tissue plasminogen,,,,, $136.12 , $136.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Acetone, Quant",,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Actaminophen,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acth,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acth Treatment,,,,, $467.46 , $467.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albumin Body Fluid,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alcohol Blood,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alcohol Urine,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aldolase,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $443.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alkaline Phosphatas,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amikacin,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amiodorone,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ammonia Blood,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amphetamine,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amylase Body Fluid,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amylase Isoenzyme,,,,, $723.98 , $723.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amylase Serum,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Androstenedione,,,,, $929.62 , $929.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antidiuretic Hormone,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antihistone Ab Quant,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apolipoprotein A,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apolipoprotein B,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arsenic Any Source,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,B Naturetic Peptide,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Barbiturates Quant,,,,, $445.20 , $445.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Basic Metabolic Panel,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bilirubin Direct,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bilirubin Total,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bupropion,,,,, $587.24 , $587.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,C Peptide,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Blood,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Ionized,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcium Urine 24,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carbon Diox Co2,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carboxyhemoglobin,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Carotene,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Catecholamines Total Urin,,,,, $710.20 , $710.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CEA,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ceruloplasmin,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chloride 24hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chloride Blood,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chloride Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholesterol Hdl,,,,, $201.40 , $201.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholesterol Total,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholinesterase Rbc,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 "," $1,577.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chromatography Quant,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Comp Metabolic Panel,,,,, $684.76 , $684.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Copper,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cortisol Am,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cortisol Pm,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cortisol Serum,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPK Isoenzymes,,,,, $412.34 , $412.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPK-Mb,,,,, $354.04 , $354.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $214.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Creatinine Clearance,,,,, $286.20 , $286.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Creatinine Serum,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Creatinine Urine Random,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cryoglobulin,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyanide,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyclosporine Level,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cystine Urine 24hr,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diazepam Assay,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Digoxin Lab,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dimeric Inhibin A,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doxepin (Sinequan),,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drug Screen Urine,,,,, $619.04 , $619.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Drug Screen:confirmation,,,,, $196.10 , $196.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D-Xylose,,,,, $526.82 , $526.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electroholresis-Serum,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electrolyte Panel,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Enzymatic Digestion,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Erythropoietin,,,,, $848.00 , $848.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estradiol Serum,,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estriol Unconjugate,,,,, $263.94 , $263.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estrogen Total,,,,, $694.30 , $694.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estrone,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fecal Fat Quant,,,,, $539.54 , $539.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fecal Fat Screen,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ferritin,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Folic Acid Rbc,,,,, $337.08 , $337.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Folic Acid, Serum",,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $607.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $474.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastrin Serum,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,General Health Panel,,,,," $1,186.14 "," $1,186.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gentamicin Level,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ggt,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucometer Lab,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose G6pd,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Random,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $64.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucsoe Blood,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Haptoglobin Quant,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemoglobin Electroph,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemoglobin Plasma,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemoglobin Urine,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemosiderin,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatic Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitus Panel,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Homocystine Serum,,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxyproline Free,,,,, $986.86 , $986.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immunoglobulin E,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $744.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immunolgobulin Igo,,,,, $677.34 , $677.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Impramine,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Total,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intrinsic Factor,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iron,,,,, $170.66 , $170.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iron Binding Capacity,,,,, $54.06 , $54.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketone Serum,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,L/S Ratio Quant,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactoferrin by Eia,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LDH Body Fluids,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LDH Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LDH Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lead Blood,,,,, $304.22 , $304.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lidocaine,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipase,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lipid Profile,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lithium Quan,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loh Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Loh Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Luteinizing Hormone,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Magnesium,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mercury,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $692.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methadone,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $728.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Microalbumin,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $603.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myoglobin Urine,,,,, $497.14 , $497.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Niacin Level,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nicotine,,,,, $243.80 , $243.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Noratriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nucleotidase 5,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Occult Blood Gastric,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Occult Blood Stool,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oligoclonal Bands,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Opiates Quantitative,,,,, $278.78 , $278.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Osmolality Blood,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Osmolality Urine,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Parathyroid Hormone,,,,, $422.94 , $422.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $409.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pcr Amplification,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ph Body Fluid,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenobarbital,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin Free,,,,, $536.36 , $536.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phosphatase Acid Total,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phosphatydylglycerol,,,,, $696.42 , $696.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Porphob Urine (Quant),,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Random Urine,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Serum,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pre Albumin,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Primidone (Mysoline),,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Procainamide,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Proclactin,,,,, $509.86 , $509.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Progesterone,,,,, $410.22 , $410.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein 24hr Urine,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein Phoresis Serum,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein Phoresis Urine,,,,, $345.56 , $345.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein Random Urine,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein S Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein Total,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PSA Total,,,,, $399.62 , $399.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pseudocholinesterase,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Quinidine Level,,,,, $358.28 , $358.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reducing Substance Stool,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renal Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Salicylate,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 "," $1,499.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sgot or AST,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sgpt or ALT,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Body Fluid,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Serum,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sodium Urine,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Specific Gravity -Other,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stone Analysis,,,,, $349.80 , $349.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stone Analysis Quan,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stone Rosk Citrate,,,,, $490.78 , $490.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stool for Reducing Substances,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,T-3 Free,,,,, $966.72 , $966.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,T-3 Resin Uptake,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,T-3 Total,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tacrolimus,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Testosterone Free,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Testosterone Total,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Theophylline Level,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thiamine Vit B1,,,,, $614.80 , $614.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroxine Free T4,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroxine Total T4,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tibc Without Iron,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tobramycin Test,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transferrin,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trazodone,,,,, $579.82 , $579.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tricyclic,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Triglycerides,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Troponin Quantitative,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Trypsinogen Serum,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tryptase Serum,,,,, $651.90 , $651.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tularemia Agglutinins,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uric Acid Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uric Acid Serum,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vancomycin Test,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vasopressin,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin A-Test,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B12,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $925.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin C Blood,,,,, $625.40 , $625.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 "," $1,055.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 "," $1,023.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin D Level,,,,," $1,085.44 "," $1,085.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vitamin E Serum,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vma Urine 24hr,,,,, $487.60 , $487.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Volatiles,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zinc Serum,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renin,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Acetylcholine Recep,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Albumin Serum,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amniostat,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti-Histone Abs,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Barbiturates Confir,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chloride Urine,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholinesterase,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Creatinine Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dhea S Serum,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Estrogen Level,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eth0suximide,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ethylene Glycol,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gloucose Body Fluid,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose 5 Hr,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glucose Whole Blood,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiaa Urine,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Iron Serum,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,L/S Ratio,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lactic Acid,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,LDH,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ldl Measured,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liver Profile,,,,, $521.00 , $521.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Methylmalonic Acid,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Misc Chem/Tox,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Osullivan,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Phosphorus Serum,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Potassium Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PSA Free,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Topiramate Quant,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Uric Acid Urine,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vma Urine,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Keppra Serum,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ketosteriods,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liver Function Test Lft,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ab Encephalitis California,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Adenovirus Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $175.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $498.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Aspergillus,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Blastomycosis,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Brucella,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Coccidioides,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Dna,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Elution,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $592.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Leptospira,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Rpn,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Sjogren,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antiphospholipid,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aso Screen,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bartonella Antibody,,,,, $662.50 , $662.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bences Jones Protein,,,,, $449.44 , $449.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blood Typing Rh (0),,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blood Typing Rh (D),,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bordetella Pertussis,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brucella Obortus,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,C Reactive Protein,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,C1 Esterase,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ca 125,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ca 15-3,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ca 19-9,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ca 27-29,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Calcitonin,,,,, $390.08 , $390.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cardiolipin Antibody,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Celiac Disease Antibod,,,,," $1,424.64 "," $1,424.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cell Total Count,,,,, $636.00 , $636.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlamydia Antibody,,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cie,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clotest/Culture Urine,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Complement Antigen,,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Complement C1 Function,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Complement C3 Antigen,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Complement C4 Antigen,,,,, $89.04 , $89.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Complement Total (Ch 50),,,,, $597.84 , $597.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crp Ultrasensitive,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cryptococcal Antigen,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytomegald Igg,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Direct Coombs,,,,, $137.80 , $137.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dna Antibody Single,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Du Typing Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ehrlichia Titer,,,,, $217.30 , $217.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Encephalitis East Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Encephalitis ST Louis,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epstein Barr (Ea),,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feb Agglut Ea,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feb Agglut Papa A,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feb Agglut Typh D,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Feb Agglut Typh H,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Frozen Blood Preparation,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fta-Abs,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $342.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $356.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis C Antibody,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis C Riba,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Herpes Simplex Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Herpes Simplex Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heterophile Abititer,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hla Typing B27,,,,, $649.78 , $649.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immundelectrophoresis,,,,, $363.58 , $363.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $546.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Islet Cell Antibody,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Legionella Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $310.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lyme Disease Antibody,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mhatp,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mitochondrial Antibody,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mono Test,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mumps Antibody,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Antibody,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pneumococcal Abs,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pooz Echinococcus,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Processing Autologous,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ra Titer,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rh Phenotyping,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $508.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rotavirus,,,,, $569.22 , $569.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rubella Igg,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rubella Specific Igm,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rubella Titer,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scheroderma Antibody,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $463.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 "," $1,043.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroglobulin Antib,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toxoplasma Igm,,,,, $405.98 , $405.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Varicella Igg,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Varicella Igm,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rubeola Titer,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vorl-Csf,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody ID,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Screen,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crossmatch is,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antithrombin Iii As,,,,, $771.68 , $771.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apc Resistance,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aptt,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Automated Platelet Count,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bleeding Time,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CBC Complete Automated,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coagulation Time Activ,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D Dimer,,,,, $517.28 , $517.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,D-Dimer Quantitative,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eosinophil Count,,,,, $181.26 , $181.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor 8 Level,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 "," $1,073.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor Ix Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor V Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor X Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor Xi Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor Xii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Factor Xiii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fibrinogen Activity,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hematocrit,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hematocrit Spun,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemoglobin,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $332.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kleihauer-Betke,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Morphology,,,,, $520.46 , $520.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Aggregation,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Countaiuid,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Countimanual,,,,, $146.28 , $146.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Function Assay #1,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Platelet Neutralization,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein C Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Protein S Total,,,,, $855.42 , $855.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PTT Practionated,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rbc Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reticulocyte Count,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $435.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sedrate-Westergren,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,WBC Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wnc Diff Only,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Af N Men A/Y,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Afb ID Direct Probe,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aft Smear Only,,,,, $193.98 , $193.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ag N Men C/U,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clostridium Diff Tox,,,,, $712.32 , $712.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Anaerobic,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Blood,,,,, $84.80 , $84.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Body Fluid,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Cath Tip,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Chlamydia,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Csf,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Fungus (Blood),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Fungus (Skin),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Gc Definitive,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Genital,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $311.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Herpes Typing,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Non Urine ID,,,,, $81.62 , $81.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Sputum,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Stool Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Throat,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Throat or Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Urine,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Urine ID,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Viral,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Culture Wound Aerobic,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fungus Smear,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gram Stain,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $251.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $575.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis C Quant,,,,, $250.16 , $250.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $922.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Herpes Virus Isol,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Histoplasma Antigen,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $395.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $702.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,India Ink Prep,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Influenza B by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Jc Virus by Pcr,,,,," $1,089.68 "," $1,089.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Koh Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Legionella Antigen Urine,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Malaria Smear,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $884.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neutrophil Ab,,,,, $267.12 , $267.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ova and Parasites,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pinworm Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Refacid Fast Culture,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,RSV Rapid Test,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sensitivity Mic,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Strep Group A Antigen,,,,, $206.70 , $206.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,West Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cult Fungi Other,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cult Grp B Strep,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bile Urine,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bile Urine Auto,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reducing Substance Urine,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Timed Volume Measurement,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinalysis Macro Only,,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urinalysis Micro Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Indirect Coombs,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 "," $2,905.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $230.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clinical Consult Limited,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $149.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flow Cytometry,,,,, $577.70 , $577.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fna Evaluation,,,,, $204.58 , $204.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $532.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cytology Cell Block,,,,, $281.96 , $281.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Decalcification Procedure,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $638.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pathology Consult In Surg,,,,, $815.14 , $815.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pathology Level I,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pathology Level Ii,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pathology Level Iii,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pathology Level IV,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pathology Level V,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pathology Level Vi,,,,, $617.98 , $617.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Special Stain Group Ii,,,,, $120.84 , $120.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Special Stains Group I,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Special Stains Group Ii,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abdomen 2 Views,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abdomen 3 Views,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abdomen IV (Kub),,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abdomen IV Port,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abdomen One View,,,,, $360.00 , $360.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $869.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ac Joints Bi,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ankle Complete,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Athrect Periph Artery,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Barium Enema,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Barium Enema Red Svc,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Barium Swallow,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biliary Stone Extraction,,,,, $673.00 , $673.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Age Studies,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Density Dexa,,,,, $633.00 , $633.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Survey Limited,,,,," $1,132.00 "," $1,132.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Breast Needle Local,,,,," $1,336.00 "," $1,336.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Breast Surgical Specimen,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronchography Bi X&i,,,,," $1,106.00 "," $1,106.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $991.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 "," $1,281.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 "," $1,265.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 "," $2,238.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $852.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $670.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Clavicle Complete,,,,, $373.00 , $373.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $753.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diskographylumbar S&i,,,,," $1,339.84 "," $1,339.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abdomen Complete,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ankle 2 Views,,,,, $347.00 , $347.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elbow 2v Comp,,,,, $309.52 , $309.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elbow Min 3v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Embolization Therapy,,,,," $8,848.00 "," $8,848.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Embolization Therapy S&i,,,,," $5,008.00 "," $5,008.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hip Min 2v,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foot Min 3 Views,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Forearm 2 Views,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand 2 Views,,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hip Operative Proc,,,,, $939.16 , $939.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Min 3 Views,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $334.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hip Unilat 1 View,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $576.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ercp Biliry Duct,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Esoph With Video,,,,, $890.40 , $890.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Esophagus,,,,, $557.56 , $557.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eye for Fb,,,,, $387.96 , $387.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Facial Bone 3 Views,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Femur Min 2views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Film Copy X-Ray,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $446.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 "," $1,691.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flouro More 1 Hour,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoro Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fluoro W/O Film,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foot 2 Views,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humerus Min 2v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 "," $1,105.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $475.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ivp Retrograde,,,,," $1,017.60 "," $1,017.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $948.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 "," $1,013.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ivus Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee 3 Views,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee Min 4v,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mandible 1-3v,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mandible Min 4v,,,,, $545.90 , $545.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $492.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 "," $2,428.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 "," $2,308.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 "," $2,134.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Neck Soft Tissue,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nephrostogram,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 "," $1,580.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Optic Foramina Exam,,,,, $690.06 , $690.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orbits 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orbits 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Panorex,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pelvimetry,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 "," $1,297.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 "," $3,047.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $709.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renal Angio Bilat,,,,," $3,838.26 "," $3,838.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renal Catheter Placement,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $715.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scapula (2 Views),,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scapula Complete,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sella Turcica,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoulder 1 View,,,,, $374.18 , $374.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sialography S&i,,,,, $601.02 , $601.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinuses <3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinuses 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinuses Waters View,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skull 1-3 Views,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skull Min 4v,,,,, $648.72 , $648.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Small Bowel Series,,,,," $1,602.72 "," $1,602.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $849.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $640.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Thoracic 2v,,,,, $570.28 , $570.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sternum 1v,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sternum 2 Views,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Subtraction Study,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Svc,,,,," $1,161.76 "," $1,161.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tmj Bi,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tmj Unilat,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Toes 2 Views,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 "," $1,619.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 "," $2,174.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $910.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 "," $2,999.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Upper Gi,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Upper Gi W/Air,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Upper Gi W/Kub,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ureter Stent Placement,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 "," $1,048.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 "," $1,495.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 "," $1,827.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venography Caval Inferio,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wrist 2 Views,,,,, $288.32 , $288.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xray Reading Outside,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zygomatic Arch,,,,, $393.26 , $393.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,A/C Joints Bilateral,,,,, $205.00 , $205.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ankle Ap & Lat,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Coccyx,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colon Barium,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Colon Barium W/Air,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cystogram S&i,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elbow Ap & Lat,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elbow Complete,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Elbow Complete I/F,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foot Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foot Complete I/F,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Forearm 1 Joint,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Complete I/F,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hand Two Views,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hip 2 Views I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hip Uni Two Views,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Facial Bones Comp,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Femur,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fingers,,,,, $198.00 , $198.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foot Ap & Lat,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Humerus,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee 2 Views I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee Ap and Lateral,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Knee Completed,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kub,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mandible Complete,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mandible Copl I/F,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mandible Limited,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mastoid Complete,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nasal Bones Only,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Os Calcis,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pelvis 2 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pyelogram Retro,,,,," $1,762.00 "," $1,762.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ribs Bilateral,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ribs Unilateral,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sacroiliac,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sacrum,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scapula,,,,, $216.00 , $216.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoulder 3 Views,,,,, $335.00 , $335.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoulder Compl I/F,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Shoulder Limited,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinuses Complete,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sinuses Limited,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skull Complete,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skull Complete I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skull Limited,,,,, $261.00 , $261.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $330.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Cervical Compl,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Lumb Complete,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sternaclavc Jnts,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sternum,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tempmndublr Jnts,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tibia and Fibula,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Upper Gi Series,,,,, $609.00 , $609.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venogram Unilateral,,,,," $3,111.00 "," $3,111.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wrist Ap & Lat,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wrist Complete,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bladder Scan,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Contrast Xray Uniary,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Foot Complete 3 Views,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orbit X-Ray,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 "," $3,972.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 "," $3,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Aortic Arch,,,,," $2,463.44 "," $2,463.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 "," $1,564.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 "," $1,187.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 "," $3,897.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 "," $1,618.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 "," $3,420.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 "," $2,921.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Carotid CPT,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 "," $2,033.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 "," $3,864.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 "," $3,117.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 "," $3,878.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 "," $3,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Renal Unilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Retro Brachial,,,,," $1,313.34 "," $1,313.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 "," $2,079.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 "," $1,248.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Visceral S&i,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 "," $3,919.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angiography Spinal S&i,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 "," $2,784.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 "," $2,119.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplasty Periph Art,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 "," $2,226.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arthrography Hip S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arthrography Knee S&i,,,,," $1,246.00 "," $1,246.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 "," $1,253.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Artho Shoulder,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 "," $2,454.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aorta Abdominal,,,,," $4,554.00 "," $4,554.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 "," $3,069.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 "," $3,842.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aortoram Abdominal,,,,," $1,210.52 "," $1,210.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest 1 View I/F,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Complate 4 Views,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Inspir/Exp,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Lat Decub,,,,, $438.00 , $438.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Pa 2 Views,,,,, $556.00 , $556.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Pa Single View,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Port,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest One View,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Three Views,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chest Two Views,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 "," $7,310.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $924.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Imaging Spect,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 "," $2,138.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 "," $1,503.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $889.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cisternography,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liver Funct Study,,,,," $2,514.32 "," $2,514.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Liver Scan (Spect),,,,," $2,047.92 "," $2,047.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lung Perfusion,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Lung Ventilation Scan,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 "," $1,576.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 "," $5,828.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 "," $3,110.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Parathyroid Scan,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Scan White Blood Cell,,,,," $3,372.92 "," $3,372.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 "," $2,176.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Schilling Test W/Factor,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 "," $1,020.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Testicular Imaging,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 "," $2,054.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 "," $2,684.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 "," $1,241.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tumor Local Spect,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tumor Local Whole Body,,,,," $2,575.80 "," $2,575.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastric Emptying Scan,,,,," $5,148.42 "," $5,148.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 "," $5,990.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 "," $2,805.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastrographin Liquid,,,,, $434.60 , $434.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Chest W/Con,,,,," $4,525.14 "," $4,525.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 "," $4,650.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 "," $1,108.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 "," $4,091.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Pelvis W/Con,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Facial W/O,,,,," $1,693.00 "," $1,693.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 "," $2,254.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 "," $7,418.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 "," $1,682.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Head W/Contrast,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Head W/O Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 "," $1,966.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Iac W/O Cont,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 "," $2,941.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Neck W/Contrast,,,,," $2,894.86 "," $2,894.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 "," $3,922.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $673.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Crystal Analysis,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Abd W/Con,,,,," $2,140.14 "," $2,140.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Abd W/O Con,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 "," $3,997.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Guided Needle Loc,,,,," $2,268.40 "," $2,268.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 "," $7,174.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $842.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 "," $1,992.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 "," $3,739.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 "," $3,963.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 "," $4,854.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 "," $2,595.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 "," $3,561.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 "," $3,587.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Needle Bx,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $384.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Extremity CPT,,,,, $961.42 , $961.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Peripheral CPT,,,,," $5,450.52 "," $5,450.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Renal,,,,," $3,396.24 "," $3,396.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angio Visceral CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 "," $4,096.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 "," $5,325.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplasty Iliac,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aorta Catheterization,,,,, $934.92 , $934.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aortogram Abd CPT,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Appl Unna Boot,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 "," $5,719.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 "," $3,491.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 "," $1,179.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherect Aorta Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 "," $3,442.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 "," $2,444.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 "," $2,200.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Lung,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $785.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $951.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 "," $1,744.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronchography Uni S&i,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 "," $2,339.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bx of Kidney CPT,,,,, $952.94 , $952.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 "," $3,093.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 "," $7,648.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 "," $7,369.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 "," $1,509.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $913.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 "," $3,933.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Central Venous Cath,,,,, $289.38 , $289.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $634.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 "," $2,374.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 "," $1,955.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Embol Extracranial CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Embolization CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $392.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ercp Radiology CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 "," $3,265.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $698.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,I&d Cyst Complex,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,I&d Cyst Simple,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 "," $1,930.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ins Chest Tube,,,,, $642.36 , $642.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insert Central Line Percu,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 "," $3,279.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 "," $4,208.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 "," $2,903.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 "," $5,344.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 "," $3,210.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $786.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $659.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $531.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 "," $3,668.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 "," $2,935.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 "," $2,024.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 "," $1,605.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 "," $2,245.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 "," $7,211.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 "," $3,402.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 "," $1,904.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $864.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 "," $3,612.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $899.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 "," $3,793.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Replc Picc Only Surg,,,,," $2,452.84 "," $2,452.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reposition Leads,,,,," $3,916.70 "," $3,916.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skin Biograft,,,,," $1,718.26 "," $1,718.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Skin Biograft Add-On,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Split Skin Graft,,,,," $3,782.08 "," $3,782.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Stent Placement,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 "," $1,386.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thoracentesis,,,,, $804.54 , $804.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 "," $2,257.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 "," $2,378.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 "," $2,167.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tissue Graft Other,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tracheostomy Planned,,,,," $3,892.32 "," $3,892.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 "," $1,170.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 "," $1,092.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 "," $3,390.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,General Anesthesia,,,,," $2,207.98 "," $2,207.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 "," $1,138.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $98.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Blood Admin,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Transfuse Blood Products,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Echo Routine,,,,, $768.50 , $768.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ultrasound Extremity,,,,," $1,598.48 "," $1,598.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Renal Sonogram,,,,," $1,749.00 "," $1,749.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 "," $2,414.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mammogram Special,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Echo Color Doppler,,,,, $703.84 , $703.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Echograhy Transrectal,,,,, $858.60 , $858.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 "," $1,080.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 "," $2,186.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Abdomen Complete,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Abdomen Limited,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Aorta,,,,," $1,011.24 "," $1,011.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Breast Bilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Breast Uni,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Gallbladder,,,,, $675.22 , $675.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 "," $6,321.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Kidney,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Pelvic Complete,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Pelvic Limited,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Retro Limited,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Scrotum,,,,, $747.30 , $747.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Thyroid,,,,, $711.26 , $711.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Transvaginal,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Us Chest,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Us Guide Vascular Access,,,,," $1,134.20 "," $1,134.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Us Kidney,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 "," $1,867.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Abg,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accapella Setup,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Accapella Treatment,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Arterial Puncture,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 "," $1,183.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronch Ther-Initial,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronch Ther-Subs,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronch With Biopsy,,,,," $1,828.00 "," $1,828.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bronch With Brushing,,,,," $1,620.00 "," $1,620.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $798.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Cpr-Code Blue,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Diag Bronch,,,,," $1,286.00 "," $1,286.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Intubation,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mdi Setup,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mdi Treatment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxygen Per Day,,,,, $359.00 , $359.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxygen Setup,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Patient Education,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peak Flow,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pft Pre & Post,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pft Simple,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulse Ox Setup,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rt Assessment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sputum Induction,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suction,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suction Set Up,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Updraft Set Up,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Updraft Treatments,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Vent Check-Daily,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPAP,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,CPAP Mask,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mdi,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Non Rebreather,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxygen Mask,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Suction Equip Daily,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Portable O2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulse Oximeter,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Prosthetic Training 15min,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Massage,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Re-Eval,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Therapeutic Proc,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT-E-Stim,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT-Wheelchair Main,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sensory Integration 15min,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Gait Training 15 Min,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Kinetic Excercises,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Evaluation,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Therap Group 15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Physical Ther. Activities,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Physical Therapy Procedures,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Evaluation/-Go,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Adl 15-Min,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $407.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $282.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Re-Eval - Go,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Tens Application - Go,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Speech Therapy,,,,, $308.46 , $308.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $618.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Speech Therapy Eval,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Swallow Clinical Eval,,,,, $854.00 , $854.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 "," $1,242.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 "," $1,745.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $754.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Echo 2d&m Complete,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Echo D&m Limited,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $489.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Echo Cardiogram,,,,," $4,562.00 "," $4,562.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Ambulance One Way,,,,," $1,214.76 "," $1,214.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Abd W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 "," $7,515.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 "," $6,315.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 "," $4,867.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 "," $6,631.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Brain W/Cont,,,,," $5,235.34 "," $5,235.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 "," $14,057.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Add'l Levels,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,MRI Head,,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mra Head Wo Cont,,,,," $1,312.28 "," $1,312.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 "," $1,906.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,General Recovery,,,,," $1,500.00 "," $1,500.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EKG,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EKG Rhythm Strip,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Electrocardiogram,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 "," $1,215.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 "," $1,196.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EEG Sleep Only,,,,," $1,587.88 "," $1,587.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 "," $1,988.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Mslt,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polysomnography W CPAP,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polysomnography W/4+param,,,,," $5,587.26 "," $5,587.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 "," $6,984.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EEG,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Hemodialysis,,,,, $549.08 , $549.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Peritoneal Dialysis,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Nursing Assessment,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Patient Education Group Sessio,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Educational 60 Mi,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Training Education 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 "," $4,011.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Tcp02,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,EMG Electromyograph,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Blue Cross,Blue Cross Ms employee,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Humana,Humana Medicare,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ",,," $135,543.52 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ",,," $13,867.43 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ",,," $9,067.98 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ",,," $33,543.90 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ",,," $27,501.22 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ",,," $7,292.35 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ",,," $30,323.94 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ",,," $32,152.06 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,884,Organic Disturbances & Mental Retardation,,,,," $20,776.82 ",,," $12,820.89 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,885,Psychoses,,,,," $22,724.68 ",,," $72,333.89 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ",,," $8,200.18 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,HCPC's,90832,Individual Psychotherapy,,,,, $250.16 ,,, $113.20 ,,,Professional fees not included
Humana,Humana Medicare,HCPC's,90834,Individual Psychotherapy,,,,, $501.38 ,,, $115.04 ,,,Professional fees not included
Humana,Humana Medicare,HCPC's,90853,Group Psychotherapy,,,,, $326.00 ,,, $68.78 ,,,Professional fees not included
Humana,Humana Medicare,DRG,,Private Room,,,,," $1,083.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Semi-Private Room,,,,," $1,051.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ICU-Room,,,,," $3,428.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CCU-Room,,,,," $3,428.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Interrupted Stay,,,,, $-   ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Code Blue,,,,, $977.32 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peg Tube Placement,,,,," $1,585.76 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perfusion 1 Hour,,,,, $369.94 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Picc Line Insertion,,,,," $2,855.64 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debride Skin Full,,,,, $436.72 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debride Skin Partial,,,,, $351.92 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulsed Lavage,,,,, $184.44 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wound Care,,,,, $568.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitiamin D 600 mg,,,,, $3.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,0.9% 10ml Flush,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,1eppra 250mg,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,250ml Bolus Ns,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,A&d Ointment,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abreva Cream 2gm,,,,, $74.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accuzyme Oint 30gm,,,,, $194.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acebutolol 200mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen 325mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen 500,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen 650mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen/Codeine,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetazolamide 250 Mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetazolamide 500mg,,,,, $236.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acyclovir 200mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acyclovir 500mg Inj,,,,, $97.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acyclovir Oint 5gm,,,,, $522.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acyclovir Susp 200mg,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adenosine  6mg Syri,,,,, $203.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aggrenox 25/200mg,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albumin 25gm 100ml,,,,, $516.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albumin 25gm Vl,,,,, $516.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 0.083% I,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol Inhaler 8,,,,, $95.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allegra D 24hr,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allopurinol 100mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alosetron 1mg Tab,,,,, $48.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alphagan 0.2% Drops,,,,, $128.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alteplase Vl 1mg,,,,, $189.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amikacin 500mg Inj,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin 1gm Inj,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin 2gm Inj,,,,, $74.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin 500mg Inj,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anucort-Hc 25mg,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aquacel  With Transparent Film,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aquaphor Oint 3oz,,,,, $34.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aspirin 325mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atenolol 25mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atropine 0.4mg Inj,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atropine 1mg Syringe,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Augementin Xr 875mg,,,,, $125.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aveeno Bath,,,,, $54.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacitracin Oint,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Beer 12oz Can,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benicar 40/12.5mg,,,,, $64.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benzocaine (Oragel),,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Black Widow Antiveni Vl,,,,, $170.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bss Irr Soln Sol,,,,, $127.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Tab : 600mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Captopril Tab : 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carmex,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celestone Mdv : 6mg,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cetaphil Mois Lot,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Charcoal Liquid  25gm,,,,, $72.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cipro 500mg Tablet,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Citrical D,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Combigan Liquid 5ml,,,,, $170.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Combivir Tablet,,,,, $523.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Copaxone 20mg Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coumadin 10 Mg,,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coumadin 7.5mg,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D10 W,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D50w 50ml Injection,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Danazol Cap : 200mg,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dapsone 100mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Destroxe 70% 500ml,,,,, $236.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 10% 1000mls,,,,, $71.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 20% 500ml,,,,, $54.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 5% 100ml,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose Amp : 0.1,,,,, $43.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilacor Xr 180mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem 180,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem 60mg,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dipentum Cap : 250mg,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Change,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ephedrine 50mg Inj,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epidrin Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epogen 1000 Units,,,,, $904.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythromycin 500mg Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol Tab : 1mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estrogens Esterified (Menest),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Etodolac Tab : 400mg,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Etoposide Vl : 10mg,,,,, $490.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrex 150mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flanders Butt Oin,,,,, $30.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fleet Prep Kit #3,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folic Acid 1mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide Xl 10mg,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucagon 1mg Inj,,,,, $501.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucosamine 500mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Gel,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucovance 5/500,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycerin Adult Supp,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycerin Pediatric Sup,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycerin Sup,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guiatuss Dac Syr,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Halothane Liquid 250ml,,,,, $554.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heparin Antibody,,,,, $100.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine 100 Mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Icy Hot Cream Cream :,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indomethacin,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Glargine (Lantus),,,,, $548.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intralipids 20% 100ml,,,,, $79.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isentress 400mg Tablet,,,,, $64.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Dinitrate,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketamine 100mg,,,,, $53.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lantus 100 Units/ML,,,,, $46.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levemir 100 Units/ML,,,,, $48.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lice Comb Ea,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lindane Shampoo 60ml,,,,, $681.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorcet 10/650,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorcet Plus,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 5,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maalox,,,,, $111.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magic Mouthwash,,,,, $75.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Citrate 8oz,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Marinol 2.5mg,,,,, $34.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maxzide 50/75,,,,, $40.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meclizine 25 Mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace 400mg/10ml,,,,, $38.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Melatonin 1 Mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Melatonin 3mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mepilex,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Merrem 250mg Ivpb,,,,, $690.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methadone 5 Mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methimazole Tab : 5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metronidazole 500mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miochol E Sol : 0.01,,,,, $250.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mivacurium Inj 2mg,,,,, $64.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mvp,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mysoline 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nabumetone 500mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nacl .9% 250ml,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nadolol 20mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naprosyn 500mg,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norcuron,,,,, $886.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin R 100 Units/ML,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolog,,,,," $2,822.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns 1000ml Bag,,,,, $64.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns 100ml Bag,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns 250ml Adv Bag,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns 250ml Bag,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns 50ml Bag,,,,, $56.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns Irrigation 3000ml,,,,, $259.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns Plus 100ml Bag,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns Plus 50ml Bag,,,,, $75.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Cream 15gm,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peg Dressing Change,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pentasa 250mg Capsule,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Petrolatum White Oin,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pindolol Tab : 5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polycitra Lc Sol,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 1mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 20mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 5mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Premarin 0.625 Mg,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prenatal Vitamin,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Preparation H Ointment,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Progesterone Microni (Prometri,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protamine 50mg Amp,,,,, $174.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinine 325mg Cap,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Refresh Tears 15ml,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renagel 800mg,,,,, $51.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip 2mg,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rifampin 300mg Cap,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 1mg/1ml,,,,, $29.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rocaltrol .25mcg,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Salsalate Tab : 750mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 25 Mg,,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 50mg,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Silver Nitrate Stick,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sorbitol 70% 30ml,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Starlix 120mg,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Water 10ml Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Streptomycin 1gm Inj,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulindac Tab : 150mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulindac Tab : 200mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Surgilube Oin : 60gm,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Symmetrel 100mg C,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Symmetrel Syr 50mg,,,,, $23.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 0.05mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 0.125mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 0.1mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tekturna 150mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetracycline 250mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thrombin 5000 Unit,,,,, $937.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid Tab : 1grain,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin,,,,, $94.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin 300mg Inh,,,,, $400.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin 80mg Inj,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trace Elements 5ml,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trental 400mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tricor 48mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urogesic Blue Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin,,,,, $73.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin 1gm Vl,,,,, $41.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin 500mg Vl,,,,, $21.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vasopressin Vl : 20units,,,,, $27.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vecuronium 10mg Inj,,,,, $49.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil 240 Mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil Tab : 120mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vfend 200mg Tablet,,,,, $764.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 ",,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Viread 300mg Tablet,,,,, $119.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vistaril 25mg,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin A 10mu Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 ,,, $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc 10mg Inj,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc 220mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc Oxide Ont,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accucheck,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,A/B Otic Drops,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 10mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 15 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 30 Mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 5 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acarbose 50 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accolate 20 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accupril 20mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acidophillus,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aciphex 20 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Actonel 35 Mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Actos 15 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Actos 30 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Actos 45mg,,,,, $182.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advair,,,,, $408.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advair Discus 250/50,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advair Diskus Inh,,,,, $819.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advanced Eye Relief,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advil 200mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aerobid,,,,, $651.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aerochamber,,,,, $225.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aggremox Cap,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aggrenox ER Caps,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Akwa Tears,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aldactone 25mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alendronate 35mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alendronate 70 Mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aleve,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Align,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allegra 180 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allegra 600 Mg,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allegra-D,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Altace 2.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Altace 5 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amaryl 2 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amaryl 4 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ambien 10mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ambien 5mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ambilify 10 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amblify 15 Mg,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlopidine-Benaz,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anafranil 25 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Analgestic Creme Rub,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anaspaz Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antacid Susp Plus,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antioxidant Vitamins,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anusol Hc Supp,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arimidex 1 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Asacol 400 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ascensia Elite #50,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Asmanex Twisthaler,,,,, $168.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aspercreme 10%,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Asprin 81mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atacand 16 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atacand 32 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atarex 25mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atenolol 100mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atenolol 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ativan 1mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ativan 2mg/ML,,,,, $115.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atrovent Inhalation,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atrovent Inhaler,,,,, $380.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avandia 2mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avandia 4mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avapro 150mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avelox 400mg,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azo Tabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,B-1,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Baclofen 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bactrim Ds,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benadryl 25 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benadryl 50 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benicar 20mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benicar 40 Mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benicar 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztrop 1 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztropine 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betapace 80 Mg,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bethameth Driprop .5,,,,, $499.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bethanechol 50mg,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biaxin 500 Mg,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisacodyl 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biscolax,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bismo 20 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisoprolol,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Black Cohosh,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blistex Lip Medex,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Boniva Tab 150,,,,, $145.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Boost,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bumex 1mg,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspar 15 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspar 5mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspirone 10 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspirone 15 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspirone 30 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspirone 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bystolic 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calan 120 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calan Sr 180mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium 600+d,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Carbonate 60,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Caltrate 600 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Campral 333 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Capoten 25mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Captopril 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Captoril 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazepine 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazepine 200mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardina 2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardura 2 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cecon Bottle,,,,, $513.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftin 250mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celebrex 100 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celebrex 200 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celexa 20 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cellcept 250mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Centrum Silver Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Century 50 Plus,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Century Senior Tabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cepacol Lozenges,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlestyramine Packet,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chloraseptic Spray,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorex-A Tablets,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorophyll 3mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorpromazine HCL,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholestyramine Packs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Citalopram 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Citalopram 20mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Citalopram 40 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clarinex 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Claritin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cleocin 150 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clobenzaprine HCL,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine .2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrim Antifungal,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clozaril 25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cogentin 2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cogentin1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Col-Benemid,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Combigan Eye Drops,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Compazine 10 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Compound Rx 30gm,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Comtan 200 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Copaxone 20mg,,,,, $390.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cordarone 200mg,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Corgard 40mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Corge 12.5 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Corona Ointment,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Correc Cr 40mg,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cosopt Eye Drops,,,,, $312.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coumadin 5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cozaar 100 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cozaar 25 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cozaar 50 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crestor 10 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cymbalta 20mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cymbalta 30mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytra K 5ml,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darvocet N 100mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darvon 65mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote 250 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depo Provera,,,,, $729.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desipramine 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desyrel 100mg,,,,, $92.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Detrol La 4 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diabeta 5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diclofenac Sod,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diflucan 150 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin 0.125mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin 250mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin 50mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem ER 120,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan 160 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan 80 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphedryl Sod,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divan 40mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Docusate Calcium,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Donnatel/Maalox,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxazosin Mesylate,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxycycline 100mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dss 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dss W/Casan,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dulcolax,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duoneb 2.5,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dyazide,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dynapen 250mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dytan 25 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Effexor Xr 150mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Effient 10 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elavil 50mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elnorm 6mg,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril 10mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril 20 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril Maleate,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Esidrix 25 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eskalith Cr,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estazolam 1 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estropipate 0.625,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Etodolac 600 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,E-Vista 60 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Evoxac 30 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exelon 3mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exelon 6 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exforge 5 320mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eye Stream 30ml,,,,, $150.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Famotidine 20 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Felodipine ER 5mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Femera 25mg,,,,, $122.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feosol,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fergon,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fexofenadine HCL,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fiber Laxative 625,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fiber Powder,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fibercon 500mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fibercon 625 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Finasteride 5mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fioricet 1 Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flagyl 500 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flonase Nasal Spray,,,,, $140.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flu Vaccine,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fludrocortisone Ace,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoprazine 2mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flurazepam,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluticasone 50mcg,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluzone,,,,, $237.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folamin Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foltx Tabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fortical Nasal Spray,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fosamax 70 Mg,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fosinopril/Hctz,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide 20mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide 80mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabitril 12mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Genasyme 80mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Genebs 500mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Genteal Drops,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 20 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 40 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 80 Mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geritol Complete,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucophage 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucotrol 5mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucovance 2.5/500,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycolax 255 Gram,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glynase 3mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guanfucine 2mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 1 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 5 Mg,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 5mg/ML,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol ML 120,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hcts 1% 30gm,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humalog Ins Inj,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humulin 70/30,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine 25mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrea 500 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hypotears Eye Drops,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hytrin,,,,, $224.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,I Caps Plus,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Imdur 30 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immitrex 50 Mg,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immodium 2mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inderal 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inderal 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inderal La 120 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inspra 25 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Humulin R,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Invega 3 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ismo 20 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isopto Tears,,,,, $175.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isordil 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Nacl,,,,, $204.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Januvia 50 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Jevity 1.5,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Juven,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K Dur 20 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keflex 250 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keflex 500mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kenalog,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keppra 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Klonopin 1 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Konsyl Powder,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Labetalol HCL,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactaid Fast Act,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamictal 100mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamictal 150mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamictal 25mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lantus Insulin 100,,,,, $147.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lantus Insulin Inj,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Latuda 40 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Laxative Suppository,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lecithin 120 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lescol 20 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lescol Xl 80mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levaquin 250 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levaquin 500mg,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levemir Vl,,,,, $519.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothroid .05 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothroid 0.125,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothroid 75mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroid 25mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 125mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levthyroxine,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lexapro 10 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lexapro 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Limbrel 500 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lioresal 10mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipitor 10 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipitor 20 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipitor 40mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril 5mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium 300 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lodine 500 Mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lofibra,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lomox Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loniten 2.5mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loperamide Hci Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lopid 600 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lopressor 25mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loratadine 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab-5,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotensin 10mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovastatin 20mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovaza 1 Gm,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovenox 40mg,,,,, $210.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loxitane 25mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lumigan Eye Drops,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lunesta 1 Mg,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lunesta 2 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lunesta 3 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lyrica 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lyrica 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lyrica 300 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maalox 0,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Macrobid 100mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mag Ox 400,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Citrate,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Oxide 241,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mavik 1 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maxzide 75/50,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medrol Dose Pak,,,,, $132.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Susp. 5ml,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mephyton 5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metaformin 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metamucil Pkt,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin 1000 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin 850 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin HCL 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methadone HCL 10mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methotrexate 25mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoclopramide 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoclopramide 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metolazone 5 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Succ,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mevacor 20 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miacalin 200u Dose,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mi-Acid Gas,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Micardis 40 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Migrazone Capsules,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Minocin 100mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miralax Packet,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miralex 255 Gm,,,,, $154.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Moban 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Moban 50 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Monopril 20mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Motrin 120ml,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Motrin 600mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Motrin Susp 5ml,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucinex 600 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multigen Plus Caplet,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multivitamin With Mineral,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Murine Tears Plus,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mylicon 80,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nadolol 20 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Namenda 10mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Namenda 5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naphcon-A 5ml,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen 250 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen 500 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen Sod,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasacort Aq,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasal Solutions,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nature Tear Drops,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Navane 5 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nb Valerian Root,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neosporin Ung Pk,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neurontin 100mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neurontin 300 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nexium 20 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nexium 40 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Niacin 250 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nifedipine 60mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Niferex 150mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nilandon 150 Mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroquick,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norco 10/325 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norpramin 25mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norvasac 5mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norvasc 10mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin 70/30,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin R 100 Units,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolog Mix 70/30,,,,, $368.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Occuvite,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Omacor 1 Gm,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Omnicef 300mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,One A Day,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,One-A-Day Mens,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Opana ER 10 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orajel,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orap 2 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Os Cal 500d,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Osteo Bi Flex,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxytrol Patch,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oyster Shell Calcium,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pancrease Ec Caps,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil 20 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil Cr 12.5,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pepcid  Complete,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Periactin 4 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peridex 473ml Sol,,,,, $179.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perparation-H Ointment,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perphenazine,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan Supp,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytek 300mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pindolol 10 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plaquenil 200mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plavix 75mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pletac 50mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pletal 100mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potass Cl Meq,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium 20mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravachol 10mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravachol 20 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravachol 40 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Precose 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisolone Acetate,,,,, $122.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 10 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prelone 5mg/ML,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Premarin Vag Cream,,,,, $167.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Preservision Softgel,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prevacid 15mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prevacid 30mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prevastatin Sod,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prisolec Otc,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pristiq 50 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine 25mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine Supp,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proscar 5 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prostate Formula,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protocream Hc 30gm,,,,, $440.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protonix 20 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protonix 40mg Tab,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Provera 5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Provigil 200 Mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prozac 10 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prozac 20 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyridoxine 100mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Questran Pckt 9g,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinapril 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinapril 20mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinapril 40 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinidine 200mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ramipril 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rampipril 10 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranexa 500 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rapamune 1 Mg,,,,, $167.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Razadyne 12 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Razadyne 8 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Refresh Eye Drops,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Relafen 500 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Remeron 15 Mg,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Remeron 30 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Remifemin Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reminyl 12mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip .25 Mg,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip 1mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Restoril 15mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rezadyne 4mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rhinocort Agua,,,,, $378.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 1mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 2 Mg,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 3 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 4 Mg,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperidone .25 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperidone .5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperidone 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperidone 4 Mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ritalan 5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Robitussin 5ml,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Robitussin Dm,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole .25mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole HCL,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rozerem 8mg,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Saphris 10 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Saphris 5 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senna Gen Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senna Plus,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sennalax-S Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senokot 187mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Septra Ds,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Serevent Disl Inh,,,,, $548.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroguel 400 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 100 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 300 Mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Serzone 100mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shopax 100 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinemet 25/100,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinemet 25/250,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Singulair 10 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skelaxin 800mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slow Fe 160mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slow K-8 Meq,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sonata 10mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sonata 5mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spiriva 18mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spiriva Handihaler,,,,, $429.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spiriva Refill,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ssystane Eye Drops,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ST John's Wart,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Starttera 40 Mg,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stool Softner,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Strattera 25 Mg,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stress W/Zinc,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sumatriptan Succ,,,,, $101.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Super Thera Vite Mt,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Symbicort 80 4.5,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Symbyax 6/25mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Symmetrel 100mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid .05 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid .2 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tamoxifen 10mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tapazole 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tarka 2/240,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tears Pure,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegretol 200mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tekurna 150 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Temazepam 15 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Temazepam 30 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tenex 1 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tenormin 25mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tenormin 50mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terazosin,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terazosin 5mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terbinafine HCL 250,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theo-24 200 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theo-Dur 300mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theophylline 300mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theragran M,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Therapeutic M,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thermotab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiamin 50 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiamine 100 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid 2 Gr,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid 30 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid 60 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tofranil 25mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tofranil 50mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topamax 100 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topiramate 100 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toprol Xl,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Torsemide 10 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Torsemide 20 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Traqzadone HCL,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazadone 150 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazadone HCL,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone 20 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone 50 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tricor 145mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trileptal 300 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trilipix 45 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trimpex 100 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tums 750 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tussin Cough 8oz,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uloric 40 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ultracet 37.5/325,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ultram 50mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uniphyl 400mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Univasc 15mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urecholine 25mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uroxatral 10mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vantin 200 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vasotec 10mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vasotec 5mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil 180 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vesicare 5mg,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Viactiv Chew Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vicon C,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vigamox Drops,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Visken 5mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin A,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B-1,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D 400 U,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Volaren 1% Gel,,,,, $222.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Voltaren 75mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin 6 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Water 45 M,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Welchol 625 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Women's One A Day,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xarelto 10 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Z0cor 20mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zanaflex 4mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zantac 150 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zelform 6 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zestril 10 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zestril 20mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zestril 5mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zetia 10 Mg,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ziac 5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc 50mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc Gluconate,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zithromax 250 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zocor 10 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zocor 40mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zocor 80 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zofran 4mg Tab,,,,, $158.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zoloft 100 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zoloft 25 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zoloft 50mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zolpidem Tartrate,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zonegran 100 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zonisamide 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zovirax,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyloprim 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyloprim 300mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 10mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 15mg,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexia 10mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyrtec 10mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 1 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 2 Mg,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acamprosate Calc 333,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accupril 40 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accupril 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accupril 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accuzyme Oint,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adderall 10 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adderall 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advair Diskus 100/50,,,,," $1,128.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advair Diskus 500/50,,,,," $1,855.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advair Hfa 115/21,,,,," $1,391.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advil Congest Rel,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Advil Pm,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Afrin  .05 Spr,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alaway Eye Drops,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 2mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol Inhaler,,,,, $293.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aldactone 50 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alendronate 35 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aleve 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allegra 60 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allopurinol 300,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Altace 1.25 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Altace 10 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amaryl 1mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amikacin 500 Inj,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlactin Lotion,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amloride 5 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin 500mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anikacin Inj 250,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apresoline 10 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arava 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aripiprazole 15mg,,,,, $159.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Armour 90 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aromasine 25 Mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Artificial Tears,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aspercreme,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Astelin Nasal Spray,,,,, $353.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atacand 8g,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atenolol,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ativan 0.5 Im,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Augmentin 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avandia 8 Mg,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ayr Nasal Mist,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azilect 1 Mg,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azmacort,,,,, $607.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azopt Drp 1%,,,,, $482.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Azor 5/40 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacid Capsules,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Baclofen 15 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Baclofen 20 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Baclofen 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacmin Tab 1,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bee Pollen,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benadryl Crm 2%,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benicar 10 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benztropine 2 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betamethasone Cream,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betoptic S Ophth,,,,, $480.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biotene Mouthwash,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisacodyl 10mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brimonidine 0.2%,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brintellix 10 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bystolic 10 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bystolic 20 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calan 80 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcarb 600 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitrate 600 + D,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium 250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium 600 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Carb 600mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calmoseptine Pks,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Caltrate 600 Plus,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate 500 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardizem 30 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardizem 60 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardura 1 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardura 4 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carmex Lip Ointment,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol 25mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Casodex 50 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefpodoxine 200,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftin 500 Mg,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cefzil 250 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celestone 2 ML Im,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celexa 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celexa 15 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celexa 40 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cellurisc 1%,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Century Senior Vitamin,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Century Vite,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cepacol Throat Spray,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cephalexin Monohydra,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cerefolin,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cerefolin Nac,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cetaphil 80z,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chantix .5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chantix 1 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholestyramine Powder,,,,, $471.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chromagen Forte,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chromium 200 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Citracal Petites,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Citrucel Each Scoop,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clarithromycin 500mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Claritin 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin Oint,,,,, $371.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine 0.1,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole 1%,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clozapine 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clozaril 100 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clozaril 50 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clozipine 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clozipine 5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cogentin 1 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colace 100mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colace 200 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colcrys .6 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colon Clenz Cap,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Combivent Respimat Inh,,,,," $1,335.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Complex + Msm,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coq-10 200 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coreg 10 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coreg 25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coreg 40 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cortef 20 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coumadin 6 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Creon Dr 3000 U,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crestor 20 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crestor 40 Mg,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crestor 5 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytomel 25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dantrolene Sodium,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Decadron 4 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Delsym Each Tsp,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote 1000 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote 1500 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote 750 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Deplin 15 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desipramine 50 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desloratadine 5mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Desonide Lot 0.05,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexilant 30 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dexilant 60 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dextrose 50% Inj,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diamox 250 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diary Digest,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diatx Tab 1,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam 1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam 2 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diflucan 100 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diflucan 200 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin 0.1mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin 0.25mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin 150 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin 200 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin 300 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin 400 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan 320 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diovan 40 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ditropan 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ditropan 5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Docusate Calcium 240,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin 25mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin 50 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin 75 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duleek Met,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dulera Inhaler,,,,," $1,241.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duoneb 3ml,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ear Wax Drps,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Effexor 225 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Effexor 50 Mg,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elavil 100 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elimite Cream 5%,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eliquis 5 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elmiron 100,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enablex 15mg Tab,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril Maleate 10,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enoxaparin 100mg,,,,, $583.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Entacapone 200 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Entacort .25 Mg,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epoetin Alfa,,,,," $4,247.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estroven Weight Mgt,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Etodolac 100mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Etodolac 400 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ex-Lax,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fanapt 1 Mg,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fanapt 2 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fanapt 4 Mg,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Felcainide 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feldene 20 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Felodipine 5mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fenofibrate 145mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feogen Ga,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fergon 27 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fergon 324 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flagyl 250 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flecainide 50 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flector 1.3% Patch,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flexeril 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flexeril 5 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Florajen Acidophilus,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Floranex Tab,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Florastor 250 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flovent Hfa,,,,," $1,507.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folacin B/6/B12,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folbee Vitiamn,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folbic,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foltanx 90 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foltrin Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Freshkote Eye Drps,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Furosemide 60 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fycompa 8 Mg,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabitril 16 Mg,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabitril 6 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabitril 8 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gas X 180 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gaviscon,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 10 Mg,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 10mg Injection,,,,, $223.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 30 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glcagon Inj,,,,, $529.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide 15 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glipizide 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucophage 250 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Tablets,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide 10 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide 3 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide 5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide 6 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gs Century Vits,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gynalotrimin,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 15 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 2 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hematogen Capsule,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemocyte Plus,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hum Benzoin Compound,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocort 2.5%,,,,, $186.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,I Car-C Plus Sr,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,I Vite,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Icaps M/V (Eye),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Imdur 20 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Imipramine 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inderal 25 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indocin 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indomethacin 25mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insta Glucose Gel,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Instaflex Joint Support,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Integra Vit,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Invokana 100 Mg,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Jantoven 5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Januvia 100 Mg,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Januvia 25 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,J-Tan D Sr,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K Clor 8 Meq,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K Dur 20 Meq,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K Dur 30 Meq,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K Dur 40 Meq,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K Phos,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 10 Meq,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kcl 8 Meq,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keppra 250 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keppra 750 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Klonopin 2 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Klor Con 10 Meq,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Klor Con 20 Meq,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Labetalol 300 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Labetalol 400 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lacrilube Oint,,,,, $108.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactaid,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactinex,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactulose 30 Cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamictal 200 Mg,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamisil,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamisil 250 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamotrigine 25mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lanacane Compound Oint,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Latuda 20 Mg,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Latuda 80 Mg,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levaquin 750 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levemir Each Unit,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levemir Flexpen,,,,," $1,510.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 500mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothroid .15mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothryoxine 88mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lexapro 15 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lexapro 30 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lexapro 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Librium 5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipitor 80 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium 150 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium 200 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium Carbonate 300,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Livalo 2 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lodrane D24,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loperamide 2 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lopressor 50 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lopressor 75 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 2.5/500,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Losartan 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Losartan 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Losartan 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotemax Opth 5%,,,,, $657.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotensin 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotensin 40 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotensin 5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loteprednol Drop,,,,, $191.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovaza Cap,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loxapine 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loxapine 50 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lyrica 200 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lyrica 50 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lyrica 75mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maalox 30 Cc,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium 250 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium 500 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medical Food 1 Tab,,,,, $188.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace 60 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megestrol 40 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Melatonin .75 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Melatonin 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Memantine HCL 10mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mestinon 60mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metafolbic Plus,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metalozone 5 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metamucil Cap,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metanx 20 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin 250 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin 500 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin 600mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin 750 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methadone 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methadone 20 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metronidazole 250mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Micardis 80 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midodrine 10 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Midrin Capsules,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Minipress 1 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Minocycline 100 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirapex 1 Mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mobic 15 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Modafinil 200 Mg,,,,, $47.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Monopril 5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Montelukast 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine 15 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucinex D,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multaq 400 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multivitimine,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mylanta 15ml,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mylanta 30 Cc,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mylanta Bottle,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mylicon 125 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nalfon 400 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naprelan 375 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen 375 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen 550 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Narco 10/325,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Narco 5/325 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasal Crom Spray,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nauzene,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neosporin,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neurontin 200 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neurontin 400 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neurontin 800mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neurontin 900 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neutro Phos 250mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Niacin 50 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine Transdermal,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nisoldipine 20mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitrolingual Spray,,,,, $487.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norco 5/325 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norflex 100 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin 100units,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolog Each Unit,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Novolog Flexpen,,,,," $1,617.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuedexta 20/10,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ocean Mist,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ocean Nasal Spray,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ointment 120 Com,,,,, $358.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 5mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Omeprazole 10mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Onfi 10 Mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Onglyza 5 Mg,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Opcon A Eye Drops,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Optive Eye Drops,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Os Cal 500 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Osphena 60 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone 5/500,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paceron 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paceron 200 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pamelor 50 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pamelor 75 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pancrelipase 10,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pangestyme Ec,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pataday Eye Drops,,,,, $662.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Patanase Nasal Spray,,,,, $535.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Patanol,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil 30 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil 40 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil 5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paxil 60 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pentazocine Nalox,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pepcid 10 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pepcid 20 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Percocet 3.75/250,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Percocet 5/325,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peri Colace,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Periactin 2 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phazyme 180 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenergan W Codine,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital 60mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phentermine 37.5mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pioglitazone 30mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pioglitazone 45mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plagic 4 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plavix 40 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plendil 10 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plendil 5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ployethylene Glycol,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pneumonia Vaccine,,,,, $173.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Ch 10meq,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Phos 250,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prandin 1 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravachol 80 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prazosin 1 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prazosin 2 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prazosin 5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 1 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 15 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 30 ML,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prednisone 40 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pregabalin 25mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pregabalin 75mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Premarin .9 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Premarin 0.3,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Premarin Cream 30g,,,,, $978.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Preparation H Supposority Box,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Preservision Gelcap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prevalite Powder,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prilosec 10 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Primidone 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Primidone 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pristiq 100 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proamatine 10 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proamatine 5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Probenecid Colchicicine,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prograf 1 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prometrium 100 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promod 30 Cc,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol 80 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prosight,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prostat 30 Cc,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Provera 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Provigil 100 Mg,,,,, $101.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prozac 40 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prozosin 1 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Psyllium See Pack,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulmocare Nutrition,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyridium 200 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Qnasl Nas Spray,,,,, $700.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Questran 2 Gm,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Questran 9gm Scoop,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinidex 300 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Qvar Inhal,,,,, $825.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ramipril 10 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Refresh Pm Ointment,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Remeron 45 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renvela 800 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip .125 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip 0.5mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip 1 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip 2 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip 4 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip 8 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Resperdol 1 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Restasis 0.5%,,,,, $815.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Restoril 30 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rifampin 150 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risamine Oint,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal 6 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperidone 2 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Risperidone 3 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ritalin 10 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ritalin 20 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ritalin 5mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rivastigmine 3mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Robaxin 500 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Saline Flush,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sam E 200 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sam E 400 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sanctura 20mg,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Santyl Top,,,,, $458.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Savella 50 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Selenium Shampoo,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senna 8.6mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sensipar 30 Mg,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Serax 30 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 150 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 500 Mg,,,,, $124.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel 75 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sertraline 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sertraline 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Silenor 3 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Silvadene Cream,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Silversulfadiazine,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simethicone 80 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinemet 12.5/50,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinex Nose Spray,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Singulair 5 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sotalol 40 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sotalol 80mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spiriva Inhaler,,,,, $444.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sporanox 100 Mg,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sps Suspension 60ml,,,,, $115.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stalevo 100 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stalevo 150 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stalevo 50 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stalevo 75 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Starlix 60 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stelazine 10 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stelazine 5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sudafed 15 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sudafed 30 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sular 17 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sular 34 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sumatriptan 100mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sumatriptan 25mg,,,,, $427.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Surmontil 25 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tagamet 400 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tamiflu,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tapazole 10 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tapazole 20 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tarvatan Drops,,,,, $514.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tavist,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegretol 150 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegretol 300 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegretol 400 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tekturna 150 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tenex 2 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terazosin 1 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theophylline 400 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theraseal Hand Cream,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tiagabine 4mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ticlid 250 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tigan 300 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tinactin Spray,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobradex Eye Oint,,,,, $334.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobradex Opth Drops,,,,, $196.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topamax 200 Mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topamax 50 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topiramate  25mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topiramate 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toradol 10 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toviaz 8 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol 100 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trandate 300 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Travoprost Eye Drops,,,,, $538.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone 150 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone 25 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone 75 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tricor 48 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trilafon 8 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trileptal 150 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trileptal 400 Mg,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trileptal 600 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trileptal 75 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trilipix 135 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trospium 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tums 1000 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tums 500 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tums 650 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Turmeric Curcumin,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol 250 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol 325 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol 500 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol 650 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol Pm,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ultracet 100,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urecholine 50 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urelle Tablet,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uricholine 25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urimar-T Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ursodiol 300mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valisone,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valium 5 Mg Im,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid 125mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid 500mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valsartan 160,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valsartan 320 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valsartan 80 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valtrex 500 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil 20 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil 40 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil 60 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil 80 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vesicare 10mg,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Viamin B Complex Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Viamint E 200iud,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Victoza Epipen,,,,, $821.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Victoza Pen Bx,,,,," $2,143.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Viibryd 40 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vimpat 100 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vimpat 200 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vimpat 50 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Visine Eye Drops,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vistaril 50 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B3 500,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Vitamin D 50,000",,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vivactil 10 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vivactil 5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Voltaren 50 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Whey Protein Isolate,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xarelto 15 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xarelto 20 Mg,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xopenex Inhaler,,,,, $328.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Z-Gen,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zioptan Eye Drops,,,,, $528.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zithromax 500 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zocor 40 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zofran 8 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zoloft 150 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zoloft 75 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zolpidem Cr 1,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zpak 250 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyrtec 5mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zyvox 600 Mg,,,,, $782.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Torsemide 5 MG,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Candesartan 8 MG,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orap 1 MG,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Norvasc 5 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CEROVITE SR TABS,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BUPROPION 75 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,venlafaxine 25 mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VYVANSE 50 MG,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ULORIC 80 MG,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CREON 12000 U,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BRILINTA 90 MG,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FUSION PLUS,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FOLBEE PLUS,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LINZESS 145 MCG,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LATUDA 60 MG,,,,, $144.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,INVOKANA 300 MG,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VIMPAT 150 MG,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DILANTIN 30 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PREPARATION H SUPP,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,REXULTI 1 MG,,,,, $149.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FARXIGA 10 MG,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,REXULTI 2 MG,,,,, $149.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MELATONIN 10 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FETZIMA 40 MG,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FETZIMA 80 MG,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NAPCON A SOL,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MELATONIN 0.5,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LIVALO 4 MG,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FE C TAB 100,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mybetriq 25 mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AZOR 10/40 MG,,,,, $49.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LABETALOL 50 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CREON 6000 U,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,REXULTI 3 MG,,,,, $160.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ATRIPLA,,,,, $399.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arginaid Powder,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coban,,,,, $10.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Descovy 200 25 mg,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estroven 1 mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lamicatal 200 mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lisinopril 15 mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metoprolol 100 mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebivolol 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pataday 2% (bottle),,,,, $594.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pataday 2% (drop),,,,, $19.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium 40mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Primidone 150mg,,,,, $10.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Propranolol 20mg,,,,, $4.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Requip 3mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Salagen 5mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tivicay 50 mg,,,,, $195.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toprol 100mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Torsemide 40mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tresiba (unit),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Warfarin 40mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zocor 20mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zocor 5mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zoloft 200mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zonisamide 75mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Naproxen 220mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinemet 50/200mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tandem Plus Capsule,,,,, $6.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LATUDA 10 MG,,,,, $99.91 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MULTILEX,,,,, $1.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LINZESS 290 MCG,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pentasa 500 MG,,,,, $29.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CENTRATEX,,,,, $4.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,REXULTI 4 MG,,,,, $184.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,SALSALATE 500MG,,,,, $71.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuplazid 34 mg,,,,, $304.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Infusion Therapy,,,,, $502.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,10ml Control Syringe,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,14fr Stylet Slip,,,,, $74.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,21 Lnr Ps,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,300cc Collection Canister,,,,, $67.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,48  Press Moniter Line,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adapter T,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Air Hose Disposable,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Air Hose Reusable,,,,, $46.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alcohol Prep Pads,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Algidex Ag Gauze,,,,, $823.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Reflux Filter,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antifungal Cream,,,,, $173.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antireflux Filter,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bacteria Filter,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Scissors,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Surepress Compression,,,,, $48.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Barrier Film,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bed Air 48,,,,, $119.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bed Air 48  Turning,,,,, $195.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betadine Sol 8oz,,,,, $83.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Betadine Swabsticks,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bite Block,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bottle 100ml Saline,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bp Cuffs Medium,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bracket  Mounting,,,,, $43.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Bridge,suture Retention",,,,, $94.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brief Adult Large,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bucks Traction Boot,,,,, $131.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calazime With Olivamine,,,,, $30.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cannula Etc02,,,,, $19.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Cap, Trach",,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carafe With Straw,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter Connector,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter Connector (Blue),,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter IV,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter Stabilization Device,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Centerpointlock Pouch,,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Tube Tray,,,,, $147.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Clamp, Beta",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Clamp, Occluding",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Cold Pack, Instant",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Commode Containers,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cone Finger Separater,,,,, $83.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cooling Blanket,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Cover, Probe",,,,, $76.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cup Medicine,,,,," $1,167.06 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debridement Tray Gss,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Del Clamp,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digital Termometer,,,,, $19.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dispo-A-Probe,,,,, $5.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Disposable Headstrap,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Disposable Lead Wires,,,,, $261.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drain Kit,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dycem Matting,,,,," $1,064.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Edema Gloves 1ea,,,,, $160.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Expiratory Filter,,,,, $43.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flexiseal Bag,,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flexiseal Management System,,,,," $2,640.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Forceps, Adson",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Full Face Mask Large,,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Full Face Mask Medium,,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Full Face Mask Small,,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gair Built Blue,,,,, $73.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Geri Chair Cushion,,,,, $169.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gloves Large Blue,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gloves Medium Blue,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucerna 1.2,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hair Brush,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Pitt Padded,,,,, $83.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemostat Absorbable,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,High Flow Humidification Syste,,,,, $167.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hip Kit,,,,, $134.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hot Packs,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrogen Peroxide,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ioban Steri Drape,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Start Kit,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kerlix Gauze,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kit Suture Removal,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee Support Brace,,,,, $328.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Label IV Day of Week,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Large Respiratory Mask,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liquid Skin Protectant,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lotion Hand/Body,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Male External Cath-Medline,,,,, $2.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask, Ear Loop",,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask, Full Face Large",,,,, $207.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask, Full Face Small",,,,, $178.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask, Nasal Small",,,,, $114.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Med Respiratory Mask,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meplix Wound Dressing,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Odor Eliminator Scented,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oral Care Kit,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Pack, Basic",,,,, $29.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Palm Cups 60mm,,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Palm Grip,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Passy Muir Valve,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Petroleum Gauze,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pneumothorax Set,,,,," $1,244.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Port Protector,,,,, $227.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pressure Port for Therapep,,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Razors,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reacher 32,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ready-Bath,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rectal Tube,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Set Catheter Irrigation,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoe Horn Long 24,,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoulder Immobilizer,,,,, $125.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shower Caps,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skin Closure Strips,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Soap Deodorant,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Speicmen Collection Commode,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spenco Boot--Outer,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Saline 100ml,,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Sheets,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Water 1000ml,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suction Canister 1200cc,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suction Canister 2400ml,,,,, $34.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suture Removal Kit,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 20cc Ll,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Syringe, Insulin",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tape Durapore 1,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tape Measure,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tape Micropore 1,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tape Transpore 1,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tape Transpore 2,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theraband Green,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Therapep,,,,, $106.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theraputty Red,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theraputty Yellow,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thick & Easy,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thigh Garment Scd,,,,, $75.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tongue Blade,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trac Y Connector,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Tray, Percutaneous",,,,, $629.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tubing Corrugated,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinal Female Guardian,,,,, $36.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinal Male Supreme,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vac Kit,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vent Circuit,,,,, $100.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vest Starter Kit,,,,, $383.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Viscopaste Pb7,,,,, $109.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitalstim Therapy,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Water Pitcher 22oz,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wedgesx2,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Weighted Bendable Fork,,,,, $60.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wing Infusion 22inch,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Winged Infusion 20in,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adult Wipes,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alcohol Preps,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alldress Dressing,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Catheter,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arm Sling,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Baby Powder,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandaid,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Briefs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Comb,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Connecting Tube,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Denture Adhesive,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Denture Cup,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Deodorant,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dressing Change Charge,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duoderm Dressing,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,E Cylinders,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enema Bag With Soap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ensure,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Extension Set,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feeding Set,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fleets Enema,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucerna,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Strip,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Graduated Container,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gt Bag,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hair and Body Shampoo,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heel Protectors,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hibiclens,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Hose, Care Knee",,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Introcan 22g 1 In,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kerlix,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kleenex,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lancet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lice Treatment,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lip Balm,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Messengile Douche,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mouthwash,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nail File,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasal Cannula,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebulizer,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,No Rinse Shampoo,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,O2 Concentrator,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perineal Cleaner,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Posie Pads,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Q-Tips,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shave Cream,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skin Prep Pad,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Slipper Socks,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Soap Bar,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Speci-Hat,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Specimen Container (Sterile),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Staple Remover Kit,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe With Needle,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Telfa Dressing,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thick It,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toothbrush,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toothette,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toothpaste,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tubing,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Underpads,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinal,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vaseline,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vial Adapter,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vista Pump,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vista Pump Set,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wash Basin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Water Pitcher,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wound Cleaner,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wound Gel,,,,, $417.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Emery Board,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Emesis Basin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,2 3/4  Wafer,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"4"" Kerlick",,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"4""drainable Pouch",,,,, $375.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ace Bandage,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adult Pullups Large,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adult Pullups Medium,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adult Pullups Small,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bed Pan,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ben Gay,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Briefs Extra Large,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Briefs Large,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Briefs Medium,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Briefs Small,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Butterfly Needle,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Autoguard 20,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Catheter, Condom",,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Catheter, Foley",,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clean Catch Kit,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colostomy Pouch,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Denture Brush,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ensure Shake,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enteral Feeding Kit,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heel Suspension Boot,,,,, $412.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Horizon Tubing,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hoyer Lift Pad,,,,, $659.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydrogel Dressing,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ileostomy Bag,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Incentive Spirometer,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulated Water Carafe,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iodine Prep,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Pump Daily,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lubricating Jelly,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lubriderm,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medseptic Packet Each,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebulizer W/Mask,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Needle,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nizoral Shampoo,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Non Adherent Pads,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ocean Spray,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Paper Tape,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Personal Belonging Bag,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Resource 8 Oz Can,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sarna Lotion,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Selson Blue Shampoo,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Speciman Cups,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Straight Catheter,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suplena 120 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 12cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 1cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 3cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 5cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ted Hose Knee High,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ted Hose Thigh High,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tinactin Powder,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Unna Boot 4""",,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vaseline Pkts,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wafer,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bariatric Bed,,,,, $300.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Air Mattress,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trapeze Bar,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wound Vac,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bariatric Lift,,,,, $160.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CATHETER MIDLINE,,,,, $328.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Catheter, short term, straight",,,,," $2,543.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blanket Bair Hugger,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,STERILE CAP MALE,,,,, $0.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,B.D. Neelde,,,,, $4.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Distilled Water,,,,, $11.19 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Steri Strips,,,,, $10.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sling Arm Large,,,,, $28.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Collar Cervical,,,,, $84.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoe Post OP,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Boot Ankle Contracute,,,,, $380.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Belt Gait 60inch,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Decannulation Plug,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abduction Wedge,,,,, $551.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Airway Guedel 70mm,,,,, $6.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Airway Guedel 80mm,,,,, $6.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Surgitube Large,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Surgitube Small,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee Immobilizer,,,,, $271.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Admission Set Up,,,,, $831.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cannula High Flow,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coloplast Clamps,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Control Mitt,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Isosource,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Jevity,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Juven,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Nepro,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Oxepa,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Prostat,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trapeze Free Standing,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Central Line Dressing Kit,,,,, $822.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eclipse Injection Needle,,,,, $2.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humid Vent 1,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aldosterone Bld,,,,, $938.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amitriptyline,,,,, $454.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Huab,,,,," $1,037.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Yob,,,,," $1,037.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Benzodiazepines,,,,, $302.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamezipine Free,,,,, $237.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath for Collection,,,,, $461.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPT Initial,,,,, $91.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPT Subsequent,,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiv-1,,,,, $274.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lead Urine,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Manual Differential,,,,, $623.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Microalbumin Urine,,,,, $283.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myoglobin,,,,, $100.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Parvo Virus Igg,,,,, $242.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Parvo Virus Igm,,,,, $242.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protime,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Smear Nasal Eos,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sputum Collection,,,,, $113.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinalysis Dipstick,,,,, $62.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venipuncture,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,West Nile Virus Igm,,,,, $94.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,340 Measure Volume,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Afb Culture,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Afb Sensitivity,,,,, $184.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ANA Titer & Pattern,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Scl 70,,,,, $184.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antigen Type,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aso Titer,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bld Type Du,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Marrow Studies,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CBC With Auto Diff,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cell Count Csf,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlamydia by Probe,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlamydia Group Ab,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cmv Igm Ql,,,,, $368.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crystal ID Synovial,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Directogen Serum,,,,, $345.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eosinphhil Count,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epstein Barr Ea,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epstein Barr Ebna,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epstein Barr Vca,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Era,,,,, $911.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Febrile Agglut Each,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fecal Fat,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fibren Split Product,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fibrinogen Quan,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flow Cytometry Dna,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,H Pylori,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Handling Fee,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemo Influenza,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiv,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiv Viral Load,,,,, $286.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiv Western Blot,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Holter Monitor 24hr,,,,, $414.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hpv Culture,,,,, $115.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iep Except Serum,,,,, $139.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iep Serum,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kell Ag Titer,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lupus Anticoagulant,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Manuel Diff,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metanephrines Urine,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Misc Immun Proc,,,,, $393.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ob Screen,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Occult Blood,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ova Paras Smears,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pertussis Smears,,,,, $162.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Cnt,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Count Auto,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pra,,,,, $911.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein Electrophore,,,,, $309.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rapid Group A Strep,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rapid Group B Strep,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Retic Absolute,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rocky Mountain Igg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,RPR,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,RPR Titer,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,RSV,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,SED Rate,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Semen Analysis Compl,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Semen Post Vasectomy,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sickle Cell Prep,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Smear Review by Path,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urea Breath Collect,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinalysis,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinalysis Chem Only,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urine Immun Fixation,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urine Microscopic,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Varicella,,,,, $147.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,WBC,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,West Nile Igm,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wet Mount,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ova Parasites Ocp,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urine 24 Hour,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urine Culture,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,WBC W Differential,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT/INR,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TPA tissue plasminogen,,,,, $136.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Acetone, Quant",,,,, $51.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Actaminophen,,,,, $355.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acth,,,,, $994.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acth Treatment,,,,, $467.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albumin Body Fluid,,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alcohol Blood,,,,, $301.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alcohol Urine,,,,, $301.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aldolase,,,,, $260.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alkaline Phosphatas,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amikacin,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amiodorone,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ammonia Blood,,,,, $375.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amphetamine,,,,, $491.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amylase Body Fluid,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amylase Isoenzyme,,,,, $723.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amylase Serum,,,,, $182.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Androstenedione,,,,, $929.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antidiuretic Hormone,,,,, $867.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antihistone Ab Quant,,,,, $427.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apolipoprotein A,,,,, $183.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apolipoprotein B,,,,, $183.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arsenic Any Source,,,,, $394.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,B Naturetic Peptide,,,,, $454.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Barbiturates Quant,,,,, $445.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Basic Metabolic Panel,,,,, $484.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bilirubin Direct,,,,, $122.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bilirubin Total,,,,, $122.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bupropion,,,,, $587.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,C Peptide,,,,, $377.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Blood,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Ionized,,,,, $453.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcium Urine 24,,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carbon Diox Co2,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carboxyhemoglobin,,,,, $209.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Carotene,,,,, $407.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Catecholamines Total Urin,,,,, $710.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CEA,,,,, $453.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ceruloplasmin,,,,, $324.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chloride 24hr Urine,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chloride Blood,,,,, $110.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chloride Random Urine,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholesterol Hdl,,,,, $201.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholesterol Total,,,,, $110.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholinesterase Rbc,,,,, $241.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chromatography Quant,,,,, $461.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Comp Metabolic Panel,,,,, $684.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Copper,,,,, $401.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cortisol Am,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cortisol Pm,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cortisol Serum,,,,, $117.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPK Isoenzymes,,,,, $412.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPK-Mb,,,,, $354.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Creatinine Clearance,,,,, $286.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Creatinine Serum,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Creatinine Urine Random,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cryoglobulin,,,,, $198.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyanide,,,,, $256.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyclosporine Level,,,,, $485.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cystine Urine 24hr,,,,, $331.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diazepam Assay,,,,, $413.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Digoxin Lab,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dimeric Inhibin A,,,,, $236.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doxepin (Sinequan),,,,, $460.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drug Screen Urine,,,,, $619.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Drug Screen:confirmation,,,,, $196.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D-Xylose,,,,, $526.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electroholresis-Serum,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electrolyte Panel,,,,, $331.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Enzymatic Digestion,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Erythropoietin,,,,, $848.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estradiol Serum,,,,, $681.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estriol Unconjugate,,,,, $263.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estrogen Total,,,,, $694.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estrone,,,,, $458.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fecal Fat Quant,,,,, $539.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fecal Fat Screen,,,,, $203.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ferritin,,,,, $321.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Folic Acid Rbc,,,,, $337.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Folic Acid, Serum",,,,, $419.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastrin Serum,,,,, $391.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,General Health Panel,,,,," $1,186.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gentamicin Level,,,,, $432.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ggt,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucometer Lab,,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose G6pd,,,,, $340.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Random,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucsoe Blood,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Haptoglobin Quant,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemoglobin Electroph,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemoglobin Plasma,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemoglobin Urine,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemosiderin,,,,, $156.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatic Function Panel,,,,, $563.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitus Panel,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Homocystine Serum,,,,, $442.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxyproline Free,,,,, $986.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immunoglobulin E,,,,, $104.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immunolgobulin Igo,,,,, $677.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Impramine,,,,, $427.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Total,,,,, $338.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intrinsic Factor,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iron,,,,, $170.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iron Binding Capacity,,,,, $54.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketone Serum,,,,, $169.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,L/S Ratio Quant,,,,, $533.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactoferrin by Eia,,,,, $216.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LDH Body Fluids,,,,, $190.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LDH Isoenzymes,,,,, $416.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LDH Serum,,,,, $190.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lead Blood,,,,, $304.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lidocaine,,,,, $407.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipase,,,,, $192.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lipid Profile,,,,, $377.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lithium Quan,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loh Isoenzymes,,,,, $416.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Loh Serum,,,,, $190.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Luteinizing Hormone,,,,, $533.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Magnesium,,,,, $51.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mercury,,,,, $338.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methadone,,,,, $454.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Microalbumin,,,,, $283.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myoglobin Urine,,,,, $497.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Niacin Level,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nicotine,,,,, $243.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Noratriptyline,,,,, $454.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nucleotidase 5,,,,, $51.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Occult Blood Gastric,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Occult Blood Stool,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oligoclonal Bands,,,,, $510.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Opiates Quantitative,,,,, $278.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Osmolality Blood,,,,, $274.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Osmolality Urine,,,,, $274.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Parathyroid Hormone,,,,, $422.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pcr Amplification,,,,, $253.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ph Body Fluid,,,,, $102.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenobarbital,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin Free,,,,, $536.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phosphatase Acid Total,,,,, $198.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phosphatydylglycerol,,,,, $696.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Porphob Urine (Quant),,,,, $326.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Random Urine,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Serum,,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pre Albumin,,,,, $110.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Primidone (Mysoline),,,,, $321.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Procainamide,,,,, $74.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Proclactin,,,,, $509.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Progesterone,,,,, $410.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein 24hr Urine,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein Phoresis Serum,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein Phoresis Urine,,,,, $345.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein Random Urine,,,,, $161.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein S Antigen,,,,, $987.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein Total,,,,, $30.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PSA Total,,,,, $399.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pseudocholinesterase,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Quinidine Level,,,,, $358.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reducing Substance Stool,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renal Function Panel,,,,, $563.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Salicylate,,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sgot or AST,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sgpt or ALT,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Body Fluid,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Random Urine,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Serum,,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sodium Urine,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Specific Gravity -Other,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stone Analysis,,,,, $349.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stone Analysis Quan,,,,, $326.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stone Rosk Citrate,,,,, $490.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stool for Reducing Substances,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,T-3 Free,,,,, $966.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,T-3 Resin Uptake,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,T-3 Total,,,,, $379.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tacrolimus,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Testosterone Free,,,,, $994.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Testosterone Total,,,,, $665.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Theophylline Level,,,,, $321.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thiamine Vit B1,,,,, $614.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroxine Free T4,,,,, $453.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroxine Total T4,,,,, $46.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tibc Without Iron,,,,, $260.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tobramycin Test,,,,, $516.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transferrin,,,,, $290.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trazodone,,,,, $579.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tricyclic,,,,, $195.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Triglycerides,,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Troponin Quantitative,,,,, $371.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Trypsinogen Serum,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tryptase Serum,,,,, $651.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tularemia Agglutinins,,,,, $246.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uric Acid Fluid,,,,, $145.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uric Acid Serum,,,,, $39.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vancomycin Test,,,,, $432.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vasopressin,,,,, $867.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin A-Test,,,,, $477.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B12,,,,, $425.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin C Blood,,,,, $625.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin D Level,,,,," $1,085.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vitamin E Serum,,,,, $413.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vma Urine 24hr,,,,, $487.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Volatiles,,,,, $212.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zinc Serum,,,,, $316.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renin,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Acetylcholine Recep,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Albumin Serum,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amniostat,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti-Histone Abs,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Barbiturates Confir,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chloride Urine,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholinesterase,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Creatinine Urine,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dhea S Serum,,,,, $186.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Estrogen Level,,,,, $242.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eth0suximide,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ethylene Glycol,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gloucose Body Fluid,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose 5 Hr,,,,, $253.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glucose Whole Blood,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiaa Urine,,,,, $150.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Iron Serum,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,L/S Ratio,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lactic Acid,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,LDH,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ldl Measured,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liver Profile,,,,, $521.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Methylmalonic Acid,,,,, $346.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Misc Chem/Tox,,,,, $208.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Osullivan,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Phosphorus Serum,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Potassium Urine,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PSA Free,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Topiramate Quant,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Uric Acid Urine,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vma Urine,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Keppra Serum,,,,, $477.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ketosteriods,,,,, $259.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liver Function Test Lft,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ab Encephalitis California,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Adenovirus Antibody,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Aspergillus,,,,, $316.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Blastomycosis,,,,, $416.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Brucella,,,,, $203.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Coccidioides,,,,, $316.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Dna,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Elution,,,,, $287.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Leptospira,,,,, $241.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Rpn,,,,, $485.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Sjogren,,,,, $485.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antiphospholipid,,,,, $116.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aso Screen,,,,, $198.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bartonella Antibody,,,,, $662.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bences Jones Protein,,,,, $449.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blood Typing Rh (0),,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blood Typing Rh (D),,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bordetella Pertussis,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brucella Obortus,,,,, $151.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,C Reactive Protein,,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,C1 Esterase,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ca 125,,,,, $523.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ca 15-3,,,,, $523.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ca 19-9,,,,, $523.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ca 27-29,,,,, $192.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Calcitonin,,,,, $390.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cardiolipin Antibody,,,,, $227.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Celiac Disease Antibod,,,,," $1,424.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cell Total Count,,,,, $636.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlamydia Antibody,,,,, $460.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cie,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clotest/Culture Urine,,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Complement Antigen,,,,, $397.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Complement C1 Function,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Complement C3 Antigen,,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Complement C4 Antigen,,,,, $89.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Complement Total (Ch 50),,,,, $597.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crp Ultrasensitive,,,,, $47.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cryptococcal Antigen,,,,, $373.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytomegald Igg,,,,, $404.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Direct Coombs,,,,, $137.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dna Antibody Single,,,,, $298.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Du Typing Only,,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ehrlichia Titer,,,,, $217.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Encephalitis East Equine,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Encephalitis ST Louis,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epstein Barr (Ea),,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feb Agglut Ea,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feb Agglut Papa A,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feb Agglut Typh D,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Feb Agglut Typh H,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Frozen Blood Preparation,,,,, $138.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fta-Abs,,,,, $287.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis C Antibody,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis C Riba,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Herpes Simplex Igg,,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Herpes Simplex Igm,,,,, $94.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heterophile Abititer,,,,, $209.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hla Typing B27,,,,, $649.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immundelectrophoresis,,,,, $363.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Islet Cell Antibody,,,,, $307.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Legionella Antibody,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lyme Disease Antibody,,,,, $516.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mhatp,,,,, $326.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mitochondrial Antibody,,,,, $413.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mono Test,,,,, $147.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mumps Antibody,,,,, $765.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Antibody,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pneumococcal Abs,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pooz Echinococcus,,,,, $60.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Processing Autologous,,,,, $719.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ra Titer,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rh Phenotyping,,,,, $161.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rotavirus,,,,, $569.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rubella Igg,,,,, $319.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rubella Specific Igm,,,,, $319.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rubella Titer,,,,, $228.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scheroderma Antibody,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroglobulin Antib,,,,, $752.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toxoplasma Igm,,,,, $405.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Varicella Igg,,,,, $235.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Varicella Igm,,,,, $235.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rubeola Titer,,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vorl-Csf,,,,, $182.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody ID,,,,, $147.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Screen,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crossmatch is,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antithrombin Iii As,,,,, $771.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apc Resistance,,,,, $258.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aptt,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Automated Platelet Count,,,,, $102.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bleeding Time,,,,, $177.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CBC Complete Automated,,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coagulation Time Activ,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D Dimer,,,,, $517.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,D-Dimer Quantitative,,,,, $195.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eosinophil Count,,,,, $181.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor 8 Level,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor Ix Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor V Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor X Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor Xi Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor Xii Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Factor Xiii Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fibrinogen Activity,,,,, $262.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hematocrit,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hematocrit Spun,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemoglobin,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kleihauer-Betke,,,,, $59.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Morphology,,,,, $520.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Aggregation,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Countaiuid,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Countimanual,,,,, $146.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Function Assay #1,,,,, $156.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Platelet Neutralization,,,,, $306.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein C Antigen,,,,, $987.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Protein S Total,,,,, $855.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PTT Practionated,,,,, $191.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rbc Count Only,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reticulocyte Count,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sedrate-Westergren,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,WBC Count Only,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wnc Diff Only,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Af N Men A/Y,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Afb ID Direct Probe,,,,, $252.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aft Smear Only,,,,, $193.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ag N Men C/U,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clostridium Diff Tox,,,,, $712.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Anaerobic,,,,, $378.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Blood,,,,, $84.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Body Fluid,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Cath Tip,,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Chlamydia,,,,, $427.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Csf,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Fungus (Blood),,,,, $562.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Fungus (Skin),,,,, $562.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Gc Definitive,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Genital,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Herpes Typing,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Non Urine ID,,,,, $81.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Nose,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Routine,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Sputum,,,,, $73.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Stool Routine,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Throat,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Throat or Nose,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Urine,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Urine ID,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Viral,,,,, $946.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Culture Wound Aerobic,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fungus Smear,,,,, $30.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gram Stain,,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis C Quant,,,,, $250.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Herpes Virus Isol,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Histoplasma Antigen,,,,, $377.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,India Ink Prep,,,,, $111.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Influenza B by Dfa,,,,, $126.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Jc Virus by Pcr,,,,," $1,089.68 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Koh Prep,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Legionella Antigen Urine,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Malaria Smear,,,,, $228.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neutrophil Ab,,,,, $267.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ova and Parasites,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pinworm Prep,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Refacid Fast Culture,,,,, $63.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,RSV Rapid Test,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sensitivity Mic,,,,, $46.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Strep Group A Antigen,,,,, $206.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,West Prep,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cult Fungi Other,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cult Grp B Strep,,,,, $605.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bile Urine,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bile Urine Auto,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reducing Substance Urine,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Timed Volume Measurement,,,,, $63.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinalysis Macro Only,,,,, $79.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urinalysis Micro Only,,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Indirect Coombs,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clinical Consult Limited,,,,, $208.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flow Cytometry,,,,, $577.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fna Evaluation,,,,, $204.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cytology Cell Block,,,,, $281.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Decalcification Procedure,,,,, $113.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pathology Consult In Surg,,,,, $815.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pathology Level I,,,,, $198.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pathology Level Ii,,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pathology Level Iii,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pathology Level IV,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pathology Level V,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pathology Level Vi,,,,, $617.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Special Stain Group Ii,,,,, $120.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Special Stains Group I,,,,, $151.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Special Stains Group Ii,,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abdomen 2 Views,,,,, $380.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abdomen 3 Views,,,,, $490.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abdomen IV (Kub),,,,, $569.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abdomen IV Port,,,,, $496.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abdomen One View,,,,, $360.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ac Joints Bi,,,,, $393.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ankle Complete,,,,, $379.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Athrect Periph Artery,,,,," $5,771.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Barium Enema,,,,, $687.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Barium Enema Red Svc,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Barium Swallow,,,,, $138.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biliary Stone Extraction,,,,, $673.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Age Studies,,,,, $572.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Density Dexa,,,,, $633.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Survey Limited,,,,," $1,132.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Breast Needle Local,,,,," $1,336.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Breast Surgical Specimen,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronchography Bi X&i,,,,," $1,106.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Clavicle Complete,,,,, $373.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diskographylumbar S&i,,,,," $1,339.84 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abdomen Complete,,,,, $568.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ankle 2 Views,,,,, $347.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elbow 2v Comp,,,,, $309.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elbow Min 3v,,,,, $366.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Embolization Therapy,,,,," $8,848.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Embolization Therapy S&i,,,,," $5,008.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hip Min 2v,,,,, $457.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foot Min 3 Views,,,,, $366.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Forearm 2 Views,,,,, $353.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand 2 Views,,,,, $294.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hip Operative Proc,,,,, $939.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Min 3 Views,,,,, $339.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hip Unilat 1 View,,,,, $314.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ercp Biliry Duct,,,,, $782.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Esoph With Video,,,,, $890.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Esophagus,,,,, $557.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eye for Fb,,,,, $387.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Facial Bone 3 Views,,,,, $558.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Femur Min 2views,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Film Copy X-Ray,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flouro More 1 Hour,,,,, $222.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoro Needle Placement,,,,," $1,069.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fluoro W/O Film,,,,," $1,467.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foot 2 Views,,,,, $361.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humerus Min 2v,,,,, $366.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ivp Retrograde,,,,," $1,017.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ivus Supervision S&i,,,,, $346.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee 3 Views,,,,, $413.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee Min 4v,,,,, $106.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mandible 1-3v,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mandible Min 4v,,,,, $545.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Neck Soft Tissue,,,,, $367.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nephrostogram,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Optic Foramina Exam,,,,, $690.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orbits 3 Views,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orbits 4 Views,,,,, $524.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Panorex,,,,, $302.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pelvimetry,,,,, $520.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renal Angio Bilat,,,,," $3,838.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renal Catheter Placement,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scapula (2 Views),,,,, $386.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scapula Complete,,,,, $386.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sella Turcica,,,,, $331.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoulder 1 View,,,,, $374.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sialography S&i,,,,, $601.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinuses <3 Views,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinuses 4 Views,,,,, $524.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinuses Waters View,,,,, $413.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skull 1-3 Views,,,,, $510.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skull Min 4v,,,,, $648.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Small Bowel Series,,,,," $1,602.72 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Thoracic 2v,,,,, $570.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sternum 1v,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sternum 2 Views,,,,, $426.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Subtraction Study,,,,, $163.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Svc,,,,," $1,161.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tmj Bi,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tmj Unilat,,,,, $439.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Toes 2 Views,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Upper Gi,,,,, $720.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Upper Gi W/Air,,,,, $746.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Upper Gi W/Kub,,,,, $835.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ureter Stent Placement,,,,, $561.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venography Caval Inferio,,,,," $1,009.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wrist 2 Views,,,,, $288.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xray Reading Outside,,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zygomatic Arch,,,,, $393.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,A/C Joints Bilateral,,,,, $205.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ankle Ap & Lat,,,,, $167.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Coccyx,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colon Barium,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Colon Barium W/Air,,,,, $536.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cystogram S&i,,,,, $471.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elbow Ap & Lat,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elbow Complete,,,,, $337.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Elbow Complete I/F,,,,, $337.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foot Complete,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foot Complete I/F,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Forearm 1 Joint,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Complete,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Complete I/F,,,,, $299.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hand Two Views,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hip 2 Views I/F,,,,, $405.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hip Ini Limited,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hip Uni Two Views,,,,, $323.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Facial Bones Comp,,,,, $306.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Femur,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fingers,,,,, $198.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foot Ap & Lat,,,,, $176.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Humerus,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee 2 Views I/F,,,,, $307.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee Ap and Lateral,,,,, $172.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Knee Completed,,,,, $247.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kub,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mandible Complete,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mandible Copl I/F,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mandible Limited,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mastoid Complete,,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nasal Bones Only,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Os Calcis,,,,, $202.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pelvis 2 Views,,,,, $311.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pyelogram Retro,,,,," $1,762.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ribs Bilateral,,,,, $369.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ribs Unilateral,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sacroiliac,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sacrum,,,,, $311.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scapula,,,,, $216.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoulder 3 Views,,,,, $335.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoulder Compl I/F,,,,, $247.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Shoulder Limited,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinuses Complete,,,,, $358.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sinuses Limited,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skull Complete,,,,, $405.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skull Complete I/F,,,,, $405.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skull Limited,,,,, $261.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Cervical Compl,,,,, $443.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Lumb Complete,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sternaclavc Jnts,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sternum,,,,, $269.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tempmndublr Jnts,,,,, $269.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tibia and Fibula,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Upper Gi Series,,,,, $609.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venogram Unilateral,,,,," $3,111.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wrist Ap & Lat,,,,, $172.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wrist Complete,,,,, $247.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bladder Scan,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Contrast Xray Uniary,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Foot Complete 3 Views,,,,, $387.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ip Ini Limited,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orbit X-Ray,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Aortic Arch,,,,," $2,463.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Carotid CPT,,,,," $2,179.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Renal Unilateral,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Retro Brachial,,,,," $1,313.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Visceral S&i,,,,," $1,442.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angiography Spinal S&i,,,,," $3,865.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplasty Periph Art,,,,," $4,492.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arthrography Hip S&i,,,,," $1,490.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arthrography Knee S&i,,,,," $1,246.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Artho Shoulder,,,,, $647.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aorta Abdominal,,,,," $4,554.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aortoram Abdominal,,,,," $1,210.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest 1 View I/F,,,,, $479.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Complate 4 Views,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Inspir/Exp,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Lat Decub,,,,, $438.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Pa 2 Views,,,,, $556.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Pa Single View,,,,, $522.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Port,,,,, $419.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest One View,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Three Views,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chest Two Views,,,,, $278.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Imaging Spect,,,,," $3,400.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cisternography,,,,," $2,567.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liver Funct Study,,,,," $2,514.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Liver Scan (Spect),,,,," $2,047.92 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lung Perfusion,,,,," $3,400.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Lung Ventilation Scan,,,,," $1,928.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Parathyroid Scan,,,,," $1,275.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Scan White Blood Cell,,,,," $3,372.92 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Schilling Test W/Factor,,,,," $1,191.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Testicular Imaging,,,,," $1,714.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tumor Local Spect,,,,," $2,794.16 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tumor Local Whole Body,,,,," $2,575.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastric Emptying Scan,,,,," $5,148.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastrographin Liquid,,,,, $434.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Chest W/Con,,,,," $4,525.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Pelvis W/Con,,,,," $4,325.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Facial W/O,,,,," $1,693.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Head W/Contrast,,,,," $1,585.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Head W/O Contrast,,,,," $2,163.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Iac W/O Cont,,,,," $3,239.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Neck W/Contrast,,,,," $2,894.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Crystal Analysis,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Abd W/Con,,,,," $2,140.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Abd W/O Con,,,,," $1,507.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Guided Needle Loc,,,,," $2,268.40 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Needle Bx,,,,," $3,383.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Extremity CPT,,,,, $961.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Peripheral CPT,,,,," $5,450.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Renal,,,,," $3,396.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angio Visceral CPT,,,,," $1,352.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplasty Iliac,,,,," $4,492.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aorta Catheterization,,,,, $934.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aortogram Abd CPT,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Appl Unna Boot,,,,, $419.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherect Aorta Surg,,,,," $2,958.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Lung,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronchography Uni S&i,,,,," $1,029.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bx of Kidney CPT,,,,, $952.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Central Venous Cath,,,,, $289.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Embol Extracranial CPT,,,,," $4,369.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Embolization CPT,,,,," $4,369.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ercp Radiology CPT,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,I&d Cyst Complex,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,I&d Cyst Simple,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ins Chest Tube,,,,, $642.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insert Central Line Percu,,,,," $2,097.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Replc Picc Only Surg,,,,," $2,452.84 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reposition Leads,,,,," $3,916.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skin Biograft,,,,," $1,718.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Skin Biograft Add-On,,,,," $1,467.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Split Skin Graft,,,,," $3,782.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Stent Placement,,,,," $2,622.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thoracentesis,,,,, $804.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tissue Graft Other,,,,," $2,234.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tracheostomy Planned,,,,," $3,892.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,General Anesthesia,,,,," $2,207.98 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Blood Admin,,,,, $213.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Transfuse Blood Products,,,,, $719.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Echo Routine,,,,, $768.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ultrasound Extremity,,,,," $1,598.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Renal Sonogram,,,,," $1,749.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mammogram Special,,,,, $117.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Echo Color Doppler,,,,, $703.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Echograhy Transrectal,,,,, $858.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Abdomen Complete,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Abdomen Limited,,,,, $892.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Aorta,,,,," $1,011.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Breast Bilateral,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Breast Uni,,,,, $485.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Gallbladder,,,,, $675.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Kidney,,,,, $892.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Pelvic Complete,,,,," $1,069.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Pelvic Limited,,,,, $977.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Retro Limited,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Scrotum,,,,, $747.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Thyroid,,,,, $711.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Transvaginal,,,,, $749.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Us Chest,,,,, $946.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Us Guide Vascular Access,,,,," $1,134.20 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Us Kidney,,,,, $946.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Abg,,,,, $208.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accapella Setup,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Accapella Treatment,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Arterial Puncture,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronch Ther-Initial,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronch Ther-Subs,,,,, $228.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronch With Biopsy,,,,," $1,828.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bronch With Brushing,,,,," $1,620.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Cpr-Code Blue,,,,, $392.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Diag Bronch,,,,," $1,286.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Intubation,,,,, $327.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mdi Setup,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mdi Treatment,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxygen Per Day,,,,, $359.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxygen Setup,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Patient Education,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peak Flow,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pft Pre & Post,,,,, $228.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pft Simple,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulse Ox Setup,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rt Assessment,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sputum Induction,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suction,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suction Set Up,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Updraft Set Up,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Updraft Treatments,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Vent Check-Daily,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPAP,,,,, $392.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,CPAP Mask,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mdi,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Non Rebreather,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxygen Mask,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Suction Equip Daily,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Portable O2,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulse Oximeter,,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Prosthetic Training 15min,,,,, $155.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Massage,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Re-Eval,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Therapeutic Proc,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT-E-Stim,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT-Wheelchair Main,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sensory Integration 15min,,,,, $138.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Gait Training 15 Min,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Kinetic Excercises,,,,, $92.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Evaluation,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Therap Group 15 Min,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Physical Ther. Activities,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Physical Therapy Procedures,,,,, $212.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Evaluation/-Go,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Adl 15-Min,,,,, $182.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Re-Eval - Go,,,,, $211.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Tens Application - Go,,,,, $206.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Speech Therapy,,,,, $308.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Speech Therapy Eval,,,,, $484.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Swallow Clinical Eval,,,,, $854.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Echo 2d&m Complete,,,,," $1,639.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Echo D&m Limited,,,,, $378.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Echo Cardiogram,,,,," $4,562.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Ambulance One Way,,,,," $1,214.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Abd W/Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Brain W/Cont,,,,," $5,235.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Add'l Levels,,,,, $835.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,MRI Head,,,,," $3,007.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mra Head Wo Cont,,,,," $1,312.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,General Recovery,,,,," $1,500.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EKG,,,,, $216.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EKG Rhythm Strip,,,,, $94.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Electrocardiogram,,,,, $191.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EEG Sleep Only,,,,," $1,587.88 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Mslt,,,,," $4,470.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polysomnography W CPAP,,,,," $2,097.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polysomnography W/4+param,,,,," $5,587.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EEG,,,,, $960.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Hemodialysis,,,,, $549.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Peritoneal Dialysis,,,,, $720.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Nursing Assessment,,,,, $500.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Patient Education Group Sessio,,,,, $390.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Educational 60 Mi,,,,, $500.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Training Education 45 or More,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Tcp02,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,EMG Electromyograph,,,,, $960.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Humana,Humana Medicare,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ",,," $135,543.52 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ",,," $13,867.43 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ",,," $9,067.98 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ",,," $33,543.90 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ",,," $27,501.22 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ",,," $7,292.35 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ",,," $30,323.94 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ",,," $32,152.06 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,884,Organic Disturbances & Mental Retardation,,,,," $20,776.82 ",,," $12,820.89 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,885,Psychoses,,,,," $22,724.68 ",,," $72,333.89 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ",,," $8,200.18 ",,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,HCPC's,90832,Individual Psychotherapy,,,,, $250.16 , $-   , $-   , $113.20 ,,,pro fees not included
Wellcare,Wellcare Medicare Managed,HCPC's,90834,Individual Psychotherapy,,,,, $501.38 , $-   , $-   , $115.04 ,,,pro fees not included
Wellcare,Wellcare Medicare Managed,HCPC's,90853,Group Psychotherapy,,,,, $326.00 , $-   , $-   , $68.78 ,,,pro fees not included
Wellcare,Wellcare Medicare Managed,DRG,,Private Room,,,,," $1,083.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Semi-Private Room,,,,," $1,051.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ICU-Room,,,,," $3,428.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CCU-Room,,,,," $3,428.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ",, $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Interrupted Stay,,,,, $-   , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Code Blue,,,,, $977.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peg Tube Placement,,,,," $1,585.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perfusion 1 Hour,,,,, $369.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Picc Line Insertion,,,,," $2,855.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debride Skin Full,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debride Skin Partial,,,,, $351.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulsed Lavage,,,,, $184.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wound Care,,,,, $568.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitiamin D 600 mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,0.9% 10ml Flush,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,1eppra 250mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,250ml Bolus Ns,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,A&d Ointment,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abreva Cream 2gm,,,,, $74.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accuzyme Oint 30gm,,,,, $194.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acebutolol 200mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen 325mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen 500,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen 650mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen/Codeine,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetazolamide 250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetazolamide 500mg,,,,, $236.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acyclovir 200mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acyclovir 500mg Inj,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acyclovir Oint 5gm,,,,, $522.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acyclovir Susp 200mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adenosine  6mg Syri,,,,, $203.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aggrenox 25/200mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albumin 25gm 100ml,,,,, $516.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albumin 25gm Vl,,,,, $516.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 0.083% I,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol Inhaler 8,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allegra D 24hr,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allopurinol 100mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alosetron 1mg Tab,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alphagan 0.2% Drops,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alteplase Vl 1mg,,,,, $189.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amikacin 500mg Inj,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin 1gm Inj,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin 2gm Inj,,,,, $74.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin 500mg Inj,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anucort-Hc 25mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aquacel  With Transparent Film,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aquaphor Oint 3oz,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aspirin 325mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atenolol 25mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atropine 0.4mg Inj,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atropine 1mg Syringe,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Augementin Xr 875mg,,,,, $125.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aveeno Bath,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacitracin Oint,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Beer 12oz Can,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benicar 40/12.5mg,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benzocaine (Oragel),,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Black Widow Antiveni Vl,,,,, $170.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bss Irr Soln Sol,,,,, $127.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Tab : 600mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Captopril Tab : 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carmex,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celestone Mdv : 6mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cetaphil Mois Lot,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Charcoal Liquid  25gm,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cipro 500mg Tablet,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Citrical D,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Combigan Liquid 5ml,,,,, $170.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Combivir Tablet,,,,, $523.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Copaxone 20mg Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coumadin 10 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coumadin 7.5mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D10 W,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D50w 50ml Injection,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Danazol Cap : 200mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dapsone 100mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Destroxe 70% 500ml,,,,, $236.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 10% 1000mls,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 20% 500ml,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 5% 100ml,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose Amp : 0.1,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilacor Xr 180mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem 180,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem 60mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dipentum Cap : 250mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Change,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ephedrine 50mg Inj,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epidrin Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epogen 1000 Units,,,,, $904.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythromycin 500mg Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol Tab : 1mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estrogens Esterified (Menest),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Etodolac Tab : 400mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Etoposide Vl : 10mg,,,,, $490.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrex 150mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flanders Butt Oin,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fleet Prep Kit #3,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folic Acid 1mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide Xl 10mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucagon 1mg Inj,,,,, $501.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucosamine 500mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Gel,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucovance 5/500,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycerin Adult Supp,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycerin Pediatric Sup,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycerin Sup,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guiatuss Dac Syr,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Halothane Liquid 250ml,,,,, $554.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heparin Antibody,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Icy Hot Cream Cream :,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indomethacin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Glargine (Lantus),,,,, $548.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intralipids 20% 100ml,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isentress 400mg Tablet,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Dinitrate,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketamine 100mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lantus 100 Units/ML,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levemir 100 Units/ML,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lice Comb Ea,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lindane Shampoo 60ml,,,,, $681.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorcet 10/650,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorcet Plus,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 5,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maalox,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magic Mouthwash,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Citrate 8oz,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Marinol 2.5mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maxzide 50/75,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meclizine 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace 400mg/10ml,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Melatonin 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Melatonin 3mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mepilex,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Merrem 250mg Ivpb,,,,, $690.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methadone 5 Mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methimazole Tab : 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metronidazole 500mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miochol E Sol : 0.01,,,,, $250.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mivacurium Inj 2mg,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mvp,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mysoline 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nabumetone 500mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nacl .9% 250ml,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nadolol 20mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naprosyn 500mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norcuron,,,,, $886.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin R 100 Units/ML,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolog,,,,," $2,822.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns 1000ml Bag,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns 100ml Bag,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns 250ml Adv Bag,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns 250ml Bag,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns 50ml Bag,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns Irrigation 3000ml,,,,, $259.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns Plus 100ml Bag,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns Plus 50ml Bag,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Cream 15gm,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peg Dressing Change,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pentasa 250mg Capsule,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Petrolatum White Oin,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pindolol Tab : 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polycitra Lc Sol,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 1mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 20mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Premarin 0.625 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prenatal Vitamin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Preparation H Ointment,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Progesterone Microni (Prometri,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protamine 50mg Amp,,,,, $174.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinine 325mg Cap,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Refresh Tears 15ml,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renagel 800mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip 2mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rifampin 300mg Cap,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 1mg/1ml,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rocaltrol .25mcg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Salsalate Tab : 750mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 50mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Silver Nitrate Stick,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sorbitol 70% 30ml,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Starlix 120mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Water 10ml Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Streptomycin 1gm Inj,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulindac Tab : 150mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulindac Tab : 200mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Surgilube Oin : 60gm,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Symmetrel 100mg C,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Symmetrel Syr 50mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 0.05mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 0.125mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 0.1mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tekturna 150mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetracycline 250mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thrombin 5000 Unit,,,,, $937.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid Tab : 1grain,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin 300mg Inh,,,,, $400.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin 80mg Inj,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trace Elements 5ml,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trental 400mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tricor 48mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urogesic Blue Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin 1gm Vl,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin 500mg Vl,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vasopressin Vl : 20units,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vecuronium 10mg Inj,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil 240 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil Tab : 120mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vfend 200mg Tablet,,,,, $764.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Viread 300mg Tablet,,,,, $119.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vistaril 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin A 10mu Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc 10mg Inj,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc 220mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc 50mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc Oxide Ont,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accucheck,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,A/B Otic Drops,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 10mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 15 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 30 Mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 5 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acarbose 50 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accolate 20 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accupril 20mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acidophillus,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aciphex 20 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Actonel 35 Mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Actos 15 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Actos 30 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Actos 45mg,,,,, $182.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advair,,,,, $408.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advair Discus 250/50,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advair Diskus Inh,,,,, $819.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advanced Eye Relief,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advil 200mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aerobid,,,,, $651.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aerochamber,,,,, $225.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aggremox Cap,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aggrenox ER Caps,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Akwa Tears,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aldactone 25mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alendronate 35mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alendronate 70 Mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aleve,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Align,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allegra 180 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allegra 600 Mg,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allegra-D,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Altace 2.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Altace 5 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amaryl 2 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amaryl 4 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ambien 10mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ambien 5mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ambilify 10 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amblify 15 Mg,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlopidine-Benaz,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anafranil 25 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Analgestic Creme Rub,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anaspaz Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antacid Susp Plus,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antioxidant Vitamins,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anusol Hc Supp,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arimidex 1 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Asacol 400 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ascensia Elite #50,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Asmanex Twisthaler,,,,, $168.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aspercreme 10%,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Asprin 81mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atacand 16 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atacand 32 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atarex 25mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atenolol 100mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atenolol 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ativan 1mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ativan 2mg/ML,,,,, $115.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atrovent Inhalation,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atrovent Inhaler,,,,, $380.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avandia 2mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avandia 4mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avapro 150mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avelox 400mg,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azo Tabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,B-1,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Baclofen 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bactrim Ds,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benadryl 25 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benadryl 50 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benicar 20mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benicar 40 Mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benicar 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztrop 1 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztropine 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betapace 80 Mg,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bethameth Driprop .5,,,,, $499.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bethanechol 50mg,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biaxin 500 Mg,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisacodyl 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biscolax,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bismo 20 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisoprolol,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Black Cohosh,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blistex Lip Medex,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Boniva Tab 150,,,,, $145.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Boost,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bumex 1mg,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspar 15 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspar 5mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspirone 10 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspirone 15 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspirone 30 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspirone 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bystolic 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calan 120 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calan Sr 180mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium 600+d,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Carbonate 60,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Caltrate 600 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Campral 333 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Capoten 25mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Captopril 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Captoril 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazepine 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazepine 200mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardina 2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardura 2 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cecon Bottle,,,,, $513.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftin 250mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celebrex 100 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celebrex 200 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celexa 20 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cellcept 250mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Centrum Silver Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Century 50 Plus,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Century Senior Tabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cepacol Lozenges,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlestyramine Packet,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chloraseptic Spray,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorex-A Tablets,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorophyll 3mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorpromazine HCL,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholestyramine Packs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Citalopram 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Citalopram 20mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Citalopram 40 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clarinex 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Claritin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cleocin 150 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clobenzaprine HCL,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine .2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrim Antifungal,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clozaril 25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cogentin 2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cogentin1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Col-Benemid,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Combigan Eye Drops,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Compazine 10 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Compound Rx 30gm,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Comtan 200 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Copaxone 20mg,,,,, $390.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cordarone 200mg,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Corgard 40mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Corge 12.5 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Corona Ointment,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Correc Cr 40mg,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cosopt Eye Drops,,,,, $312.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coumadin 5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cozaar 100 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cozaar 25 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cozaar 50 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crestor 10 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cymbalta 20mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cymbalta 30mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytra K 5ml,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darvocet N 100mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darvon 65mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote 250 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depo Provera,,,,, $729.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desipramine 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desyrel 100mg,,,,, $92.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Detrol La 4 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diabeta 5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diclofenac Sod,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diflucan 150 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin 0.125mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin 250mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin 50mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem ER 120,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan 160 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan 80 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphedryl Sod,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divan 40mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Docusate Calcium,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Donnatel/Maalox,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxazosin Mesylate,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxycycline 100mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dss 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dss W/Casan,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dulcolax,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duoneb 2.5,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dyazide,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dynapen 250mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dytan 25 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Effexor Xr 150mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Effient 10 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elavil 50mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elnorm 6mg,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril 10mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril 20 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril Maleate,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Esidrix 25 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eskalith Cr,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estazolam 1 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estropipate 0.625,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Etodolac 600 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,E-Vista 60 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Evoxac 30 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exelon 3mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exelon 6 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exforge 5 320mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eye Stream 30ml,,,,, $150.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Famotidine 20 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Felodipine ER 5mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Femera 25mg,,,,, $122.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feosol,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fergon,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fexofenadine HCL,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fiber Laxative 625,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fiber Powder,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fibercon 500mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fibercon 625 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Finasteride 5mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fioricet 1 Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flagyl 500 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flonase Nasal Spray,,,,, $140.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flu Vaccine,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fludrocortisone Ace,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoprazine 2mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flurazepam,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluticasone 50mcg,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluzone,,,,, $237.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folamin Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foltx Tabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fortical Nasal Spray,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fosamax 70 Mg,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fosinopril/Hctz,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide 20mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide 80mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabitril 12mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Genasyme 80mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Genebs 500mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Genteal Drops,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 20 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 40 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 80 Mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geritol Complete,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucophage 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucotrol 5mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucovance 2.5/500,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycolax 255 Gram,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glynase 3mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guanfucine 2mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 1 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 5 Mg,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 5mg/ML,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol ML 120,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hcts 1% 30gm,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humalog Ins Inj,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humulin 70/30,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine 25mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrea 500 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hypotears Eye Drops,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hytrin,,,,, $224.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,I Caps Plus,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Imdur 30 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immitrex 50 Mg,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immodium 2mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inderal 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inderal 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inderal La 120 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inspra 25 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Humulin R,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Invega 3 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ismo 20 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isopto Tears,,,,, $175.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isordil 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Nacl,,,,, $204.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Januvia 50 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Jevity 1.5,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Juven,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K Dur 20 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keflex 250 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keflex 500mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kenalog,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keppra 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Klonopin 1 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Konsyl Powder,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Labetalol HCL,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactaid Fast Act,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamictal 100mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamictal 150mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamictal 25mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lantus Insulin 100,,,,, $147.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lantus Insulin Inj,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Latuda 40 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Laxative Suppository,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lecithin 120 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lescol 20 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lescol Xl 80mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levaquin 250 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levaquin 500mg,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levemir Vl,,,,, $519.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothroid .05 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothroid 0.125,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothroid 75mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroid 25mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 125mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levthyroxine,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lexapro 10 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lexapro 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Limbrel 500 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lioresal 10mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipitor 10 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipitor 20 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipitor 40mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril 5mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium 300 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lodine 500 Mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lofibra,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lomox Tablet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loniten 2.5mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loperamide Hci Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lopid 600 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lopressor 25mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loratadine 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab-5,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotensin 10mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovastatin 20mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovaza 1 Gm,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovenox 40mg,,,,, $210.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loxitane 25mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lumigan Eye Drops,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lunesta 1 Mg,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lunesta 2 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lunesta 3 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lyrica 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lyrica 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lyrica 300 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maalox 0,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Macrobid 100mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mag Ox 400,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Citrate,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Oxide 241,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mavik 1 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maxzide 75/50,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medrol Dose Pak,,,,, $132.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Susp. 5ml,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mephyton 5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metaformin 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metamucil Pkt,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin 1000 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin 850 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin HCL 500mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methadone HCL 10mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methotrexate 25mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoclopramide 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoclopramide 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metolazone 5 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol 25mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Succ,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mevacor 20 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miacalin 200u Dose,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mi-Acid Gas,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Micardis 40 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Migrazone Capsules,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Minocin 100mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miralax Packet,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miralex 255 Gm,,,,, $154.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Moban 25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Moban 50 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Monopril 20mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Motrin 120ml,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Motrin 600mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Motrin Susp 5ml,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucinex 600 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multigen Plus Caplet,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multivitamin With Mineral,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Murine Tears Plus,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mylicon 80,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nadolol 20 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Namenda 10mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Namenda 5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naphcon-A 5ml,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen 250 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen 500 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen Sod,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasacort Aq,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasal Solutions,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nature Tear Drops,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Navane 5 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nb Valerian Root,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neosporin Ung Pk,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neurontin 100mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neurontin 300 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nexium 20 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nexium 40 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Niacin 250 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nifedipine 60mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Niferex 150mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nilandon 150 Mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroquick,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norco 10/325 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norpramin 25mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norvasac 5mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norvasc 10mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin 70/30,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin R 100 Units,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolog Mix 70/30,,,,, $368.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Occuvite,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Omacor 1 Gm,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Omnicef 300mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,One A Day,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,One-A-Day Mens,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Opana ER 10 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orajel,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orap 2 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Os Cal 500d,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Osteo Bi Flex,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxytrol Patch,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oyster Shell Calcium,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pancrease Ec Caps,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil 20 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil Cr 12.5,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pepcid  Complete,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Periactin 4 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peridex 473ml Sol,,,,, $179.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perparation-H Ointment,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perphenazine,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan Supp,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytek 300mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pindolol 10 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plaquenil 200mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plavix 75mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pletac 50mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pletal 100mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potass Cl Meq,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium 20mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravachol 10mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravachol 20 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravachol 40 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Precose 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisolone Acetate,,,,, $122.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 10 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prelone 5mg/ML,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Premarin Vag Cream,,,,, $167.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Preservision Softgel,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prevacid 15mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prevacid 30mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prevastatin Sod,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prisolec Otc,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pristiq 50 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine 25mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine Supp,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proscar 5 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prostate Formula,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protocream Hc 30gm,,,,, $440.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protonix 20 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protonix 40mg Tab,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Provera 5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Provigil 200 Mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prozac 10 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prozac 20 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyridoxine 100mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Questran Pckt 9g,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinapril 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinapril 20mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinapril 40 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinidine 200mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ramipril 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rampipril 10 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranexa 500 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rapamune 1 Mg,,,,, $167.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Razadyne 12 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Razadyne 8 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Refresh Eye Drops,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Relafen 500 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Remeron 15 Mg,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Remeron 30 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Remifemin Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reminyl 12mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip .25 Mg,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip 1mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Restoril 15mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rezadyne 4mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rhinocort Agua,,,,, $378.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 1mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 2 Mg,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 3 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 4 Mg,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperidone .25 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperidone .5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperidone 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperidone 4 Mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ritalan 5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Robitussin 5ml,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Robitussin Dm,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole .25mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole HCL,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rozerem 8mg,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Saphris 10 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Saphris 5 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senna Gen Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senna Plus,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sennalax-S Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senokot 187mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Septra Ds,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Serevent Disl Inh,,,,, $548.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroguel 400 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 100 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 300 Mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Serzone 100mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shopax 100 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinemet 25/100,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinemet 25/250,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Singulair 10 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skelaxin 800mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slow Fe 160mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slow K-8 Meq,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sonata 10mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sonata 5mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spiriva 18mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spiriva Handihaler,,,,, $429.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spiriva Refill,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ssystane Eye Drops,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ST John's Wart,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Starttera 40 Mg,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stool Softner,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Strattera 25 Mg,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stress W/Zinc,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sumatriptan Succ,,,,, $101.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Super Thera Vite Mt,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Symbicort 80 4.5,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Symbyax 6/25mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Symmetrel 100mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid .05 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid .2 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tamoxifen 10mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tapazole 5mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tarka 2/240,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tears Pure,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegretol 200mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tekurna 150 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Temazepam 15 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Temazepam 30 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tenex 1 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tenormin 25mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tenormin 50mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terazosin,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terazosin 5mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terbinafine HCL 250,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theo-24 200 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theo-Dur 300mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theophylline 300mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theragran M,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Therapeutic M,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thermotab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiamin 50 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiamine 100 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid 2 Gr,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid 30 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid 60 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tofranil 25mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tofranil 50mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topamax 100 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topiramate 100 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toprol Xl,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Torsemide 10 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Torsemide 20 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol 50mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Traqzadone HCL,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazadone 150 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazadone HCL,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone 20 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone 50 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tricor 145mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trileptal 300 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trilipix 45 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trimpex 100 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tums 750 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tussin Cough 8oz,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uloric 40 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ultracet 37.5/325,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ultram 50mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uniphyl 400mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Univasc 15mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urecholine 25mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uroxatral 10mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vantin 200 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vasotec 10mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vasotec 5mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil 180 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vesicare 5mg,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Viactiv Chew Tab,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vicon C,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vigamox Drops,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Visken 5mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin A,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B-1,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D 400 U,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Volaren 1% Gel,,,,, $222.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Voltaren 75mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin 6 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Water 45 M,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Welchol 625 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Women's One A Day,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xarelto 10 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Z0cor 20mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zanaflex 4mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zantac 150 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zelform 6 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zestril 10 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zestril 20mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zestril 5mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zetia 10 Mg,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ziac 5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc 50mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc Gluconate,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zithromax 250 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zocor 10 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zocor 40mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zocor 80 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zofran 4mg Tab,,,,, $158.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zoloft 100 Mg,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zoloft 25 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zoloft 50mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zolpidem Tartrate,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zonegran 100 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zonisamide 100mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zovirax,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyloprim 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyloprim 300mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 10mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 15mg,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexia 10mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyrtec 10mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 1 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 2 Mg,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acamprosate Calc 333,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accupril 40 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accupril 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accupril 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accuzyme Oint,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adderall 10 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adderall 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advair Diskus 100/50,,,,," $1,128.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advair Diskus 500/50,,,,," $1,855.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advair Hfa 115/21,,,,," $1,391.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advil Congest Rel,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Advil Pm,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Afrin  .05 Spr,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alaway Eye Drops,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 2mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol Inhaler,,,,, $293.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aldactone 50 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alendronate 35 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aleve 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allegra 60 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allopurinol 300,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Altace 1.25 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Altace 10 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amaryl 1mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amikacin 500 Inj,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlactin Lotion,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amloride 5 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin 500mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anikacin Inj 250,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apresoline 10 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arava 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aripiprazole 15mg,,,,, $159.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Armour 90 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aromasine 25 Mg,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Artificial Tears,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aspercreme,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Astelin Nasal Spray,,,,, $353.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atacand 8g,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atenolol,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ativan 0.5 Im,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Augmentin 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avandia 8 Mg,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ayr Nasal Mist,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azilect 1 Mg,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azmacort,,,,, $607.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azopt Drp 1%,,,,, $482.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Azor 5/40 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacid Capsules,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Baclofen 15 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Baclofen 20 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Baclofen 5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacmin Tab 1,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bee Pollen,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benadryl Crm 2%,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benicar 10 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benztropine 2 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betamethasone Cream,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betoptic S Ophth,,,,, $480.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biotene Mouthwash,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisacodyl 10mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brimonidine 0.2%,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brintellix 10 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bystolic 10 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bystolic 20 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calan 80 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcarb 600 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitrate 600 + D,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium 250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium 600 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Carb 600mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calmoseptine Pks,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Caltrate 600 Plus,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate 500 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardizem 30 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardizem 60 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardura 1 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardura 4 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carmex Lip Ointment,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol 25mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Casodex 50 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefpodoxine 200,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftin 500 Mg,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cefzil 250 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celestone 2 ML Im,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celexa 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celexa 15 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celexa 40 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cellurisc 1%,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Century Senior Vitamin,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Century Vite,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cepacol Throat Spray,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cephalexin Monohydra,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cerefolin,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cerefolin Nac,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cetaphil 80z,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chantix .5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chantix 1 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholestyramine Powder,,,,, $471.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chromagen Forte,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chromium 200 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Citracal Petites,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Citrucel Each Scoop,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clarithromycin 500mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Claritin 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin Oint,,,,, $371.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine 0.1,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole 1%,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clozapine 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clozaril 100 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clozaril 50 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clozipine 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clozipine 5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cogentin 1 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colace 100mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colace 200 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colcrys .6 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colon Clenz Cap,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Combivent Respimat Inh,,,,," $1,335.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Complex + Msm,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coq-10 200 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coreg 10 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coreg 25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coreg 40 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cortef 20 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coumadin 6 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Creon Dr 3000 U,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crestor 20 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crestor 40 Mg,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crestor 5 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytomel 25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dantrolene Sodium,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Decadron 4 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Delsym Each Tsp,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote 1000 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote 1500 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote 750 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Deplin 15 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desipramine 50 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desloratadine 5mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Desonide Lot 0.05,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexilant 30 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dexilant 60 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dextrose 50% Inj,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diamox 250 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diary Digest,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diatx Tab 1,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam 1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam 2 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diflucan 100 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diflucan 200 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin 0.1mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin 0.25mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin 150 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin 200 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin 300 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin 400 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan 320 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diovan 40 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ditropan 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ditropan 5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Docusate Calcium 240,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin 25mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin 50 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin 75 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duleek Met,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dulera Inhaler,,,,," $1,241.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duoneb 3ml,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ear Wax Drps,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Effexor 225 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Effexor 50 Mg,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elavil 100 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elimite Cream 5%,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eliquis 5 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elmiron 100,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enablex 15mg Tab,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril Maleate 10,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enoxaparin 100mg,,,,, $583.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Entacapone 200 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Entacort .25 Mg,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epoetin Alfa,,,,," $4,247.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estroven Weight Mgt,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Etodolac 100mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Etodolac 400 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ex-Lax,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fanapt 1 Mg,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fanapt 2 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fanapt 4 Mg,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Felcainide 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feldene 20 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Felodipine 5mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fenofibrate 145mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feogen Ga,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fergon 27 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fergon 324 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flagyl 250 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flecainide 50 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flector 1.3% Patch,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flexeril 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flexeril 5 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Florajen Acidophilus,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Floranex Tab,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Florastor 250 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flovent Hfa,,,,," $1,507.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folacin B/6/B12,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folbee Vitiamn,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folbic,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foltanx 90 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foltrin Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Freshkote Eye Drps,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Furosemide 60 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fycompa 8 Mg,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabitril 16 Mg,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabitril 6 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabitril 8 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gas X 180 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gaviscon,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 10 Mg,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 10mg Injection,,,,, $223.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 30 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glcagon Inj,,,,, $529.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide 15 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glipizide 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucophage 250 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Tablets,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide 10 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide 3 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide 5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide 6 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gs Century Vits,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gynalotrimin,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 15 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 2 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hematogen Capsule,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemocyte Plus,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hum Benzoin Compound,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocort 2.5%,,,,, $186.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,I Car-C Plus Sr,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,I Vite,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Icaps M/V (Eye),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Imdur 20 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Imipramine 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inderal 25 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indocin 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indomethacin 25mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insta Glucose Gel,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Instaflex Joint Support,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Integra Vit,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Invokana 100 Mg,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Jantoven 5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Januvia 100 Mg,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Januvia 25 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,J-Tan D Sr,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K Clor 8 Meq,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K Dur 20 Meq,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K Dur 30 Meq,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K Dur 40 Meq,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K Phos,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 10 Meq,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kcl 8 Meq,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keppra 250 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keppra 750 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Klonopin 2 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Klor Con 10 Meq,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Klor Con 20 Meq,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Labetalol 300 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Labetalol 400 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lacrilube Oint,,,,, $108.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactaid,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactinex,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactulose 30 Cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamictal 200 Mg,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamisil,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamisil 250 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamotrigine 25mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lanacane Compound Oint,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Latuda 20 Mg,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Latuda 80 Mg,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levaquin 750 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levemir Each Unit,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levemir Flexpen,,,,," $1,510.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 500mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothroid .15mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothryoxine 88mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lexapro 15 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lexapro 30 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lexapro 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Librium 5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipitor 80 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium 150 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium 200 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium Carbonate 300,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Livalo 2 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lodrane D24,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loperamide 2 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lopressor 50 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lopressor 75 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 2.5/500,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Losartan 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Losartan 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Losartan 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotemax Opth 5%,,,,, $657.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotensin 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotensin 40 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotensin 5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loteprednol Drop,,,,, $191.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovaza Cap,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loxapine 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loxapine 50 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lyrica 200 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lyrica 50 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lyrica 75mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maalox 30 Cc,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium 250 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium 500 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medical Food 1 Tab,,,,, $188.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace 60 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megestrol 40 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Melatonin .75 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Melatonin 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Memantine HCL 10mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mestinon 60mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metafolbic Plus,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metalozone 5 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metamucil Cap,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metanx 20 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin 250 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin 500 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin 600mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin 750 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methadone 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methadone 20 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metronidazole 250mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Micardis 80 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midodrine 10 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Midrin Capsules,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Minipress 1 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Minocycline 100 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirapex 1 Mg,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mobic 15 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Modafinil 200 Mg,,,,, $47.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Monopril 5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Montelukast 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine 15 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucinex D,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multaq 400 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multivitimine,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mylanta 15ml,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mylanta 30 Cc,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mylanta Bottle,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mylicon 125 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nalfon 400 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naprelan 375 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen 375 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen 550 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Narco 10/325,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Narco 5/325 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasal Crom Spray,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nauzene,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neosporin,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neurontin 200 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neurontin 400 Mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neurontin 800mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neurontin 900 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neutro Phos 250mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Niacin 50 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine Transdermal,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nisoldipine 20mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitrolingual Spray,,,,, $487.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norco 5/325 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norflex 100 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin 100units,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolog Each Unit,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Novolog Flexpen,,,,," $1,617.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuedexta 20/10,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ocean Mist,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ocean Nasal Spray,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ointment 120 Com,,,,, $358.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 5mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Omeprazole 10mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Onfi 10 Mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Onglyza 5 Mg,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Opcon A Eye Drops,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Optive Eye Drops,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Os Cal 500 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Osphena 60 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone 5/500,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paceron 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paceron 200 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pamelor 50 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pamelor 75 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pancrelipase 10,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pangestyme Ec,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pataday Eye Drops,,,,, $662.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Patanase Nasal Spray,,,,, $535.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Patanol,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil 30 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil 40 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil 5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paxil 60 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pentazocine Nalox,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pepcid 10 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pepcid 20 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Percocet 3.75/250,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Percocet 5/325,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peri Colace,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Periactin 2 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phazyme 180 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenergan W Codine,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital 60mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phentermine 37.5mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pioglitazone 30mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pioglitazone 45mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plagic 4 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plavix 40 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plendil 10 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plendil 5 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ployethylene Glycol,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pneumonia Vaccine,,,,, $173.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Ch 10meq,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Phos 250,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prandin 1 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravachol 80 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prazosin 1 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prazosin 2 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prazosin 5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 1 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 15 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 30 ML,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prednisone 40 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pregabalin 25mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pregabalin 75mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Premarin .9 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Premarin 0.3,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Premarin Cream 30g,,,,, $978.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Preparation H Supposority Box,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Preservision Gelcap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prevalite Powder,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prilosec 10 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Primidone 25 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Primidone 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pristiq 100 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proamatine 10 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proamatine 5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Probenecid Colchicicine,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prograf 1 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prometrium 100 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promod 30 Cc,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol 80 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prosight,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prostat 30 Cc,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Provera 10 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Provigil 100 Mg,,,,, $101.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prozac 40 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prozosin 1 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Psyllium See Pack,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulmocare Nutrition,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyridium 200 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Qnasl Nas Spray,,,,, $700.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Questran 2 Gm,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Questran 9gm Scoop,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinidex 300 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Qvar Inhal,,,,, $825.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ramipril 10 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Refresh Pm Ointment,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Remeron 45 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renvela 800 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip .125 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip 0.5mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip 1 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip 2 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip 4 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip 8 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Resperdol 1 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Restasis 0.5%,,,,, $815.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Restoril 30 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rifampin 150 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risamine Oint,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal 6 Mg,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperidone 2 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Risperidone 3 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ritalin 10 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ritalin 20 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ritalin 5mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rivastigmine 3mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Robaxin 500 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Saline Flush,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sam E 200 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sam E 400 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sanctura 20mg,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Santyl Top,,,,, $458.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Savella 50 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Selenium Shampoo,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senna 8.6mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sensipar 30 Mg,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Serax 30 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 150 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 500 Mg,,,,, $124.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel 75 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sertraline 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sertraline 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Silenor 3 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Silvadene Cream,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Silversulfadiazine,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simethicone 80 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinemet 12.5/50,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinex Nose Spray,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Singulair 5 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sotalol 40 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sotalol 80mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spiriva Inhaler,,,,, $444.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sporanox 100 Mg,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sps Suspension 60ml,,,,, $115.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stalevo 100 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stalevo 150 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stalevo 50 Mg,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stalevo 75 Mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Starlix 60 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stelazine 10 Mg,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stelazine 5 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sudafed 15 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sudafed 30 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sular 17 Mg,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sular 34 Mg,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sumatriptan 100mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sumatriptan 25mg,,,,, $427.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Surmontil 25 Mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tagamet 400 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tamiflu,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tapazole 10 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tapazole 20 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tarvatan Drops,,,,, $514.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tavist,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegretol 150 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegretol 300 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegretol 400 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tekturna 150 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tenex 2 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terazosin 1 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theophylline 400 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theraseal Hand Cream,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tiagabine 4mg,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ticlid 250 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tigan 300 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tinactin Spray,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobradex Eye Oint,,,,, $334.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobradex Opth Drops,,,,, $196.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topamax 200 Mg,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topamax 50 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topiramate  25mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topiramate 50 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toradol 10 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toviaz 8 Mg,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol 100 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol 25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trandate 300 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Travoprost Eye Drops,,,,, $538.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone 150 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone 200 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone 25 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone 75 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tricor 48 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trilafon 8 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trileptal 150 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trileptal 400 Mg,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trileptal 600 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trileptal 75 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trilipix 135 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trospium 20 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tums 1000 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tums 500 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tums 650 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Turmeric Curcumin,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol 250 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol 325 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol 500 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol 650 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol Pm,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ultracet 100,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urecholine 50 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urelle Tablet,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uricholine 25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urimar-T Tab,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ursodiol 300mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valisone,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valium 5 Mg Im,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid 125mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid 500mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valsartan 160,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valsartan 320 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valsartan 80 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valtrex 500 Mg,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil 20 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil 40 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil 60 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil 80 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vesicare 10mg,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Viamin B Complex Tab,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Viamint E 200iud,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Victoza Epipen,,,,, $821.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Victoza Pen Bx,,,,," $2,143.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Viibryd 40 Mg,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vimpat 100 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vimpat 200 Mg,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vimpat 50 Mg,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Visine Eye Drops,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vistaril 50 Mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B3 500,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Vitamin D 50,000",,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vivactil 10 Mg,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vivactil 5 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Voltaren 50 Mg,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin 10 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Whey Protein Isolate,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xarelto 15 Mg,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xarelto 20 Mg,,,,, $50.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xopenex Inhaler,,,,, $328.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Z-Gen,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zioptan Eye Drops,,,,, $528.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zithromax 500 Mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zocor 40 Mg,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zofran 8 Mg,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zoloft 150 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zoloft 75 Mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zolpidem Cr 1,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zpak 250 Mg,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyrtec 5mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zyvox 600 Mg,,,,, $782.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Torsemide 5 MG,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Candesartan 8 MG,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orap 1 MG,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Norvasc 5 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CEROVITE SR TABS,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BUPROPION 75 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,venlafaxine 25 mg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VYVANSE 50 MG,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ULORIC 80 MG,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CREON 12000 U,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BRILINTA 90 MG,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FUSION PLUS,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FOLBEE PLUS,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LINZESS 145 MCG,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LATUDA 60 MG,,,,, $144.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,INVOKANA 300 MG,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VIMPAT 150 MG,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DILANTIN 30 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PREPARATION H SUPP,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,REXULTI 1 MG,,,,, $149.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FARXIGA 10 MG,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,REXULTI 2 MG,,,,, $149.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MELATONIN 10 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FETZIMA 40 MG,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FETZIMA 80 MG,,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NAPCON A SOL,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MELATONIN 0.5,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LIVALO 4 MG,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FE C TAB 100,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mybetriq 25 mg,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AZOR 10/40 MG,,,,, $49.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LABETALOL 50 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CREON 6000 U,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,REXULTI 3 MG,,,,, $160.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ATRIPLA,,,,, $399.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arginaid Powder,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coban,,,,, $10.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Descovy 200 25 mg,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estroven 1 mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lamicatal 200 mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lisinopril 15 mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metoprolol 100 mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebivolol 10mg,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pataday 2% (bottle),,,,, $594.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pataday 2% (drop),,,,, $19.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium 10mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium 40mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Primidone 150mg,,,,, $10.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Propranolol 20mg,,,,, $4.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Requip 3mg,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Salagen 5mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tivicay 50 mg,,,,, $195.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toprol 100mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Torsemide 40mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tresiba (unit),,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Warfarin 40mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zocor 20mg,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zocor 5mg,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zoloft 200mg,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zonisamide 75mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Naproxen 220mg,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinemet 50/200mg,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tandem Plus Capsule,,,,, $6.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LATUDA 10 MG,,,,, $99.91 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MULTILEX,,,,, $1.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LINZESS 290 MCG,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pentasa 500 MG,,,,, $29.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CENTRATEX,,,,, $4.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,REXULTI 4 MG,,,,, $184.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,SALSALATE 500MG,,,,, $71.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuplazid 34 mg,,,,, $304.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Infusion Therapy,,,,, $502.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,10ml Control Syringe,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,14fr Stylet Slip,,,,, $74.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,21 Lnr Ps,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,300cc Collection Canister,,,,, $67.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,48  Press Moniter Line,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adapter T,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Air Hose Disposable,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Air Hose Reusable,,,,, $46.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alcohol Prep Pads,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Algidex Ag Gauze,,,,, $823.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Reflux Filter,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antifungal Cream,,,,, $173.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antireflux Filter,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bacteria Filter,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Scissors,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Surepress Compression,,,,, $48.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Barrier Film,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bed Air 48,,,,, $119.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bed Air 48  Turning,,,,, $195.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betadine Sol 8oz,,,,, $83.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Betadine Swabsticks,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bite Block,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bottle 100ml Saline,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bp Cuffs Medium,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bracket  Mounting,,,,, $43.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Bridge,suture Retention",,,,, $94.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brief Adult Large,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bucks Traction Boot,,,,, $131.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calazime With Olivamine,,,,, $30.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cannula Etc02,,,,, $19.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Cap, Trach",,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carafe With Straw,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter Connector,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter Connector (Blue),,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter IV,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter Stabilization Device,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Centerpointlock Pouch,,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Tube Tray,,,,, $147.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Clamp, Beta",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Clamp, Occluding",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Cold Pack, Instant",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Commode Containers,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cone Finger Separater,,,,, $83.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cooling Blanket,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Cover, Probe",,,,, $76.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cup Medicine,,,,," $1,167.06 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debridement Tray Gss,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Del Clamp,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digital Termometer,,,,, $19.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dispo-A-Probe,,,,, $5.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Disposable Headstrap,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Disposable Lead Wires,,,,, $261.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drain Kit,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dycem Matting,,,,," $1,064.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Edema Gloves 1ea,,,,, $160.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Expiratory Filter,,,,, $43.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flexiseal Bag,,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flexiseal Management System,,,,," $2,640.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Forceps, Adson",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Full Face Mask Large,,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Full Face Mask Medium,,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Full Face Mask Small,,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gair Built Blue,,,,, $73.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Geri Chair Cushion,,,,, $169.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gloves Large Blue,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gloves Medium Blue,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucerna 1.2,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hair Brush,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Pitt Padded,,,,, $83.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemostat Absorbable,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,High Flow Humidification Syste,,,,, $167.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hip Kit,,,,, $134.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hot Packs,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrogen Peroxide,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ioban Steri Drape,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Start Kit,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kerlix Gauze,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kit Suture Removal,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee Support Brace,,,,, $328.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Label IV Day of Week,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Large Respiratory Mask,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liquid Skin Protectant,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lotion Hand/Body,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Male External Cath-Medline,,,,, $2.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask, Ear Loop",,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask, Full Face Large",,,,, $207.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask, Full Face Small",,,,, $178.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask, Nasal Small",,,,, $114.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Med Respiratory Mask,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meplix Wound Dressing,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Odor Eliminator Scented,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oral Care Kit,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Pack, Basic",,,,, $29.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Palm Cups 60mm,,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Palm Grip,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Passy Muir Valve,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Petroleum Gauze,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pneumothorax Set,,,,," $1,244.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Port Protector,,,,, $227.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pressure Port for Therapep,,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Razors,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reacher 32,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ready-Bath,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rectal Tube,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Set Catheter Irrigation,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoe Horn Long 24,,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoulder Immobilizer,,,,, $125.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shower Caps,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skin Closure Strips,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Soap Deodorant,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Speicmen Collection Commode,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spenco Boot--Outer,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Saline 100ml,,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Sheets,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Water 1000ml,,,,, $24.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suction Canister 1200cc,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suction Canister 2400ml,,,,, $34.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suture Removal Kit,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 20cc Ll,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Syringe, Insulin",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tape Durapore 1,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tape Measure,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tape Micropore 1,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tape Transpore 1,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tape Transpore 2,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theraband Green,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Therapep,,,,, $106.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theraputty Red,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theraputty Yellow,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thick & Easy,,,,, $27.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thigh Garment Scd,,,,, $75.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tongue Blade,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trac Y Connector,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Tray, Percutaneous",,,,, $629.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tubing Corrugated,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinal Female Guardian,,,,, $36.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinal Male Supreme,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vac Kit,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vent Circuit,,,,, $100.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vest Starter Kit,,,,, $383.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Viscopaste Pb7,,,,, $109.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitalstim Therapy,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Water Pitcher 22oz,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wedgesx2,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Weighted Bendable Fork,,,,, $60.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wing Infusion 22inch,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Winged Infusion 20in,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adult Wipes,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alcohol Preps,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alldress Dressing,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Catheter,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arm Sling,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Baby Powder,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandaid,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Briefs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Comb,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Connecting Tube,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Denture Adhesive,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Denture Cup,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Deodorant,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dressing Change Charge,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duoderm Dressing,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,E Cylinders,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enema Bag With Soap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ensure,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Extension Set,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feeding Set,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fleets Enema,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucerna,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Strip,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Graduated Container,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gt Bag,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hair and Body Shampoo,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heel Protectors,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hibiclens,,,,, $30.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Hose, Care Knee",,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Introcan 22g 1 In,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kerlix,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kleenex,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lancet,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lice Treatment,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lip Balm,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Messengile Douche,,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mouthwash,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nail File,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasal Cannula,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebulizer,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,No Rinse Shampoo,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,O2 Concentrator,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perineal Cleaner,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Posie Pads,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Q-Tips,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shave Cream,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skin Prep Pad,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Slipper Socks,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Soap Bar,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Speci-Hat,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Specimen Container (Sterile),,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Staple Remover Kit,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe With Needle,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Telfa Dressing,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thick It,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toothbrush,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toothette,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toothpaste,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tubing,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Underpads,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinal,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vaseline,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vial Adapter,,,,, $51.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vista Pump,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vista Pump Set,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wash Basin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Water Pitcher,,,,, $8.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wound Cleaner,,,,, $43.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wound Gel,,,,, $417.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Emery Board,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Emesis Basin,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,2 3/4  Wafer,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"4"" Kerlick",,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"4""drainable Pouch",,,,, $375.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ace Bandage,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adult Pullups Large,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adult Pullups Medium,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adult Pullups Small,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bed Pan,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ben Gay,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Briefs Extra Large,,,,, $25.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Briefs Large,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Briefs Medium,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Briefs Small,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Butterfly Needle,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Autoguard 20,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Catheter, Condom",,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Catheter, Foley",,,,, $23.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clean Catch Kit,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colostomy Pouch,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Denture Brush,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ensure Shake,,,,, $12.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enteral Feeding Kit,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heel Suspension Boot,,,,, $412.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Horizon Tubing,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hoyer Lift Pad,,,,, $659.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydrogel Dressing,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ileostomy Bag,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Incentive Spirometer,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulated Water Carafe,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iodine Prep,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Pump Daily,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lubricating Jelly,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lubriderm,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medseptic Packet Each,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebulizer W/Mask,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Needle,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nizoral Shampoo,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Non Adherent Pads,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ocean Spray,,,,, $5.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Paper Tape,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Personal Belonging Bag,,,,, $1.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Resource 8 Oz Can,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sarna Lotion,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Selson Blue Shampoo,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Speciman Cups,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Straight Catheter,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suplena 120 Mg,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 12cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 1cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 3cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 5cc,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ted Hose Knee High,,,,, $27.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ted Hose Thigh High,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tinactin Powder,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Unna Boot 4""",,,,, $46.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vaseline Pkts,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wafer,,,,, $19.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bariatric Bed,,,,, $300.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Air Mattress,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trapeze Bar,,,,, $40.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wound Vac,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bariatric Lift,,,,, $160.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CATHETER MIDLINE,,,,, $328.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Catheter, short term, straight",,,,," $2,543.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blanket Bair Hugger,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,STERILE CAP MALE,,,,, $0.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,B.D. Neelde,,,,, $4.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Distilled Water,,,,, $11.19 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Steri Strips,,,,, $10.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sling Arm Large,,,,, $28.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Collar Cervical,,,,, $84.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoe Post OP,,,,, $37.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Boot Ankle Contracute,,,,, $380.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Belt Gait 60inch,,,,, $33.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Decannulation Plug,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abduction Wedge,,,,, $551.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Airway Guedel 70mm,,,,, $6.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Airway Guedel 80mm,,,,, $6.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Surgitube Large,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Surgitube Small,,,,, $17.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee Immobilizer,,,,, $271.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Admission Set Up,,,,, $831.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cannula High Flow,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coloplast Clamps,,,,, $11.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Control Mitt,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Isosource,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Jevity,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Juven,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Nepro,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Oxepa,,,,, $26.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Prostat,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trapeze Free Standing,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Central Line Dressing Kit,,,,, $822.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eclipse Injection Needle,,,,, $2.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humid Vent 1,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aldosterone Bld,,,,, $938.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amitriptyline,,,,, $454.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Huab,,,,," $1,037.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Yob,,,,," $1,037.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Benzodiazepines,,,,, $302.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamezipine Free,,,,, $237.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath for Collection,,,,, $461.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPT Initial,,,,, $91.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPT Subsequent,,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiv-1,,,,, $274.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lead Urine,,,,, $71.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Manual Differential,,,,, $623.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Microalbumin Urine,,,,, $283.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myoglobin,,,,, $100.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Parvo Virus Igg,,,,, $242.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Parvo Virus Igm,,,,, $242.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protime,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Smear Nasal Eos,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sputum Collection,,,,, $113.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinalysis Dipstick,,,,, $62.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venipuncture,,,,, $15.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,West Nile Virus Igm,,,,, $94.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,340 Measure Volume,,,,, $14.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Afb Culture,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Afb Sensitivity,,,,, $184.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ANA Titer & Pattern,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Scl 70,,,,, $184.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antigen Type,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aso Titer,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bld Type Du,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Marrow Studies,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CBC With Auto Diff,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cell Count Csf,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlamydia by Probe,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlamydia Group Ab,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cmv Igm Ql,,,,, $368.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crystal ID Synovial,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Directogen Serum,,,,, $345.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eosinphhil Count,,,,, $35.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epstein Barr Ea,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epstein Barr Ebna,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epstein Barr Vca,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Era,,,,, $911.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Febrile Agglut Each,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fecal Fat,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fibren Split Product,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fibrinogen Quan,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flow Cytometry Dna,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,H Pylori,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Handling Fee,,,,, $15.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemo Influenza,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiv,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiv Viral Load,,,,, $286.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiv Western Blot,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Holter Monitor 24hr,,,,, $414.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hpv Culture,,,,, $115.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iep Except Serum,,,,, $139.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iep Serum,,,,, $126.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kell Ag Titer,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lupus Anticoagulant,,,,, $135.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Manuel Diff,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metanephrines Urine,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Misc Immun Proc,,,,, $393.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ob Screen,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Occult Blood,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ova Paras Smears,,,,, $83.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pertussis Smears,,,,, $162.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Cnt,,,,, $54.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Count Auto,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pra,,,,, $911.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein Electrophore,,,,, $309.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rapid Group A Strep,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rapid Group B Strep,,,,, $104.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Retic Absolute,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rocky Mountain Igg,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,RPR,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,RPR Titer,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,RSV,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,SED Rate,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Semen Analysis Compl,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Semen Post Vasectomy,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sickle Cell Prep,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Smear Review by Path,,,,, $38.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urea Breath Collect,,,,, $21.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinalysis,,,,, $81.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinalysis Chem Only,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urine Immun Fixation,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urine Microscopic,,,,, $42.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Varicella,,,,, $147.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,WBC,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,West Nile Igm,,,,, $118.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wet Mount,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ova Parasites Ocp,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urine 24 Hour,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urine Culture,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,WBC W Differential,,,,, $16.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT/INR,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TPA tissue plasminogen,,,,, $136.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Acetone, Quant",,,,, $51.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Actaminophen,,,,, $355.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acth,,,,, $994.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acth Treatment,,,,, $467.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albumin Body Fluid,,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alcohol Blood,,,,, $301.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alcohol Urine,,,,, $301.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aldolase,,,,, $260.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alkaline Phosphatas,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amikacin,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amiodorone,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ammonia Blood,,,,, $375.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amphetamine,,,,, $491.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amylase Body Fluid,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amylase Isoenzyme,,,,, $723.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amylase Serum,,,,, $182.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Androstenedione,,,,, $929.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antidiuretic Hormone,,,,, $867.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antihistone Ab Quant,,,,, $427.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apolipoprotein A,,,,, $183.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apolipoprotein B,,,,, $183.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arsenic Any Source,,,,, $394.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,B Naturetic Peptide,,,,, $454.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Barbiturates Quant,,,,, $445.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Basic Metabolic Panel,,,,, $484.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bilirubin Direct,,,,, $122.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bilirubin Total,,,,, $122.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bupropion,,,,, $587.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,C Peptide,,,,, $377.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Blood,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Ionized,,,,, $453.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcium Urine 24,,,,, $72.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carbon Diox Co2,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carboxyhemoglobin,,,,, $209.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Carotene,,,,, $407.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Catecholamines Total Urin,,,,, $710.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CEA,,,,, $453.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ceruloplasmin,,,,, $324.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chloride 24hr Urine,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chloride Blood,,,,, $110.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chloride Random Urine,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholesterol Hdl,,,,, $201.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholesterol Total,,,,, $110.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholinesterase Rbc,,,,, $241.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chromatography Quant,,,,, $461.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Comp Metabolic Panel,,,,, $684.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Copper,,,,, $401.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cortisol Am,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cortisol Pm,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cortisol Serum,,,,, $117.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPK Isoenzymes,,,,, $412.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPK-Mb,,,,, $354.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Creatinine Clearance,,,,, $286.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Creatinine Serum,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Creatinine Urine Random,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cryoglobulin,,,,, $198.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyanide,,,,, $256.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyclosporine Level,,,,, $485.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cystine Urine 24hr,,,,, $331.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diazepam Assay,,,,, $413.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Digoxin Lab,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dimeric Inhibin A,,,,, $236.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doxepin (Sinequan),,,,, $460.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drug Screen Urine,,,,, $619.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Drug Screen:confirmation,,,,, $196.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D-Xylose,,,,, $526.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electroholresis-Serum,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electrolyte Panel,,,,, $331.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Enzymatic Digestion,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Erythropoietin,,,,, $848.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estradiol Serum,,,,, $681.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estriol Unconjugate,,,,, $263.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estrogen Total,,,,, $694.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estrone,,,,, $458.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fecal Fat Quant,,,,, $539.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fecal Fat Screen,,,,, $203.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ferritin,,,,, $321.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Folic Acid Rbc,,,,, $337.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Folic Acid, Serum",,,,, $419.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastrin Serum,,,,, $391.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,General Health Panel,,,,," $1,186.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gentamicin Level,,,,, $432.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ggt,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucometer Lab,,,,, $21.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose G6pd,,,,, $340.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Random,,,,, $25.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucsoe Blood,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Haptoglobin Quant,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemoglobin Electroph,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemoglobin Plasma,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemoglobin Urine,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemosiderin,,,,, $156.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatic Function Panel,,,,, $563.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitus Panel,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Homocystine Serum,,,,, $442.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxyproline Free,,,,, $986.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immunoglobulin E,,,,, $104.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immunolgobulin Igo,,,,, $677.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Impramine,,,,, $427.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Total,,,,, $338.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intrinsic Factor,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iron,,,,, $170.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iron Binding Capacity,,,,, $54.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketone Serum,,,,, $169.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,L/S Ratio Quant,,,,, $533.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactoferrin by Eia,,,,, $216.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LDH Body Fluids,,,,, $190.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LDH Isoenzymes,,,,, $416.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LDH Serum,,,,, $190.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lead Blood,,,,, $304.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lidocaine,,,,, $407.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipase,,,,, $192.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lipid Profile,,,,, $377.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lithium Quan,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loh Isoenzymes,,,,, $416.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Loh Serum,,,,, $190.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Luteinizing Hormone,,,,, $533.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Magnesium,,,,, $51.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mercury,,,,, $338.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methadone,,,,, $454.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Microalbumin,,,,, $283.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myoglobin Urine,,,,, $497.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Niacin Level,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nicotine,,,,, $243.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Noratriptyline,,,,, $454.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nucleotidase 5,,,,, $51.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Occult Blood Gastric,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Occult Blood Stool,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oligoclonal Bands,,,,, $510.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Opiates Quantitative,,,,, $278.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Osmolality Blood,,,,, $274.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Osmolality Urine,,,,, $274.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Parathyroid Hormone,,,,, $422.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pcr Amplification,,,,, $253.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ph Body Fluid,,,,, $102.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenobarbital,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin Free,,,,, $536.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phosphatase Acid Total,,,,, $198.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phosphatydylglycerol,,,,, $696.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Porphob Urine (Quant),,,,, $326.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Random Urine,,,,, $7.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Serum,,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pre Albumin,,,,, $110.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Primidone (Mysoline),,,,, $321.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Procainamide,,,,, $74.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Proclactin,,,,, $509.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Progesterone,,,,, $410.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein 24hr Urine,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein Phoresis Serum,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein Phoresis Urine,,,,, $345.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein Random Urine,,,,, $161.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein S Antigen,,,,, $987.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein Total,,,,, $30.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PSA Total,,,,, $399.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pseudocholinesterase,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Quinidine Level,,,,, $358.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reducing Substance Stool,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renal Function Panel,,,,, $563.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Salicylate,,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sgot or AST,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sgpt or ALT,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Body Fluid,,,,, $115.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Random Urine,,,,, $8.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Serum,,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sodium Urine,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Specific Gravity -Other,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stone Analysis,,,,, $349.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stone Analysis Quan,,,,, $326.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stone Rosk Citrate,,,,, $490.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stool for Reducing Substances,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,T-3 Free,,,,, $966.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,T-3 Resin Uptake,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,T-3 Total,,,,, $379.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tacrolimus,,,,, $65.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Testosterone Free,,,,, $994.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Testosterone Total,,,,, $665.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Theophylline Level,,,,, $321.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thiamine Vit B1,,,,, $614.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroxine Free T4,,,,, $453.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroxine Total T4,,,,, $46.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tibc Without Iron,,,,, $260.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tobramycin Test,,,,, $516.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transferrin,,,,, $290.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trazodone,,,,, $579.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tricyclic,,,,, $195.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Triglycerides,,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Troponin Quantitative,,,,, $371.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Trypsinogen Serum,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tryptase Serum,,,,, $651.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tularemia Agglutinins,,,,, $246.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uric Acid Fluid,,,,, $145.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uric Acid Serum,,,,, $39.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vancomycin Test,,,,, $432.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vasopressin,,,,, $867.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin A-Test,,,,, $477.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B12,,,,, $425.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin C Blood,,,,, $625.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin D Level,,,,," $1,085.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vitamin E Serum,,,,, $413.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vma Urine 24hr,,,,, $487.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Volatiles,,,,, $212.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zinc Serum,,,,, $316.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renin,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Acetylcholine Recep,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Albumin Serum,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amniostat,,,,, $84.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti-Histone Abs,,,,, $49.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Barbiturates Confir,,,,, $68.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chloride Urine,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholinesterase,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Creatinine Urine,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dhea S Serum,,,,, $186.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Estrogen Level,,,,, $242.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eth0suximide,,,,, $64.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ethylene Glycol,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gloucose Body Fluid,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose,,,,, $60.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose 5 Hr,,,,, $253.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glucose Whole Blood,,,,, $24.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiaa Urine,,,,, $150.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Iron Serum,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,L/S Ratio,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lactic Acid,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,LDH,,,,, $89.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ldl Measured,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liver Profile,,,,, $521.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Methylmalonic Acid,,,,, $346.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Misc Chem/Tox,,,,, $208.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Osullivan,,,,, $41.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Phosphorus Serum,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Potassium Urine,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PSA Free,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Topiramate Quant,,,,, $100.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Uric Acid Urine,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vma Urine,,,,, $157.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Keppra Serum,,,,, $477.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ketosteriods,,,,, $259.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liver Function Test Lft,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ab Encephalitis California,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Adenovirus Antibody,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Aspergillus,,,,, $316.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Blastomycosis,,,,, $416.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Brucella,,,,, $203.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Coccidioides,,,,, $316.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Dna,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Elution,,,,, $287.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Leptospira,,,,, $241.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Rpn,,,,, $485.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Sjogren,,,,, $485.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antiphospholipid,,,,, $116.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aso Screen,,,,, $198.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bartonella Antibody,,,,, $662.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bences Jones Protein,,,,, $449.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blood Typing Rh (0),,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blood Typing Rh (D),,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bordetella Pertussis,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brucella Obortus,,,,, $151.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,C Reactive Protein,,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,C1 Esterase,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ca 125,,,,, $523.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ca 15-3,,,,, $523.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ca 19-9,,,,, $523.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ca 27-29,,,,, $192.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Calcitonin,,,,, $390.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cardiolipin Antibody,,,,, $227.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Celiac Disease Antibod,,,,," $1,424.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cell Total Count,,,,, $636.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlamydia Antibody,,,,, $460.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cie,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clotest/Culture Urine,,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Complement Antigen,,,,, $397.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Complement C1 Function,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Complement C3 Antigen,,,,, $78.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Complement C4 Antigen,,,,, $89.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Complement Total (Ch 50),,,,, $597.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crp Ultrasensitive,,,,, $47.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cryptococcal Antigen,,,,, $373.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytomegald Igg,,,,, $404.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Direct Coombs,,,,, $137.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dna Antibody Single,,,,, $298.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Du Typing Only,,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ehrlichia Titer,,,,, $217.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Encephalitis East Equine,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Encephalitis ST Louis,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epstein Barr (Ea),,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feb Agglut Ea,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feb Agglut Papa A,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feb Agglut Typh D,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Feb Agglut Typh H,,,,, $40.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Frozen Blood Preparation,,,,, $138.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fta-Abs,,,,, $287.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis C Antibody,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis C Riba,,,,, $12.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Herpes Simplex Igg,,,,, $31.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Herpes Simplex Igm,,,,, $94.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heterophile Abititer,,,,, $209.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hla Typing B27,,,,, $649.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immundelectrophoresis,,,,, $363.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Islet Cell Antibody,,,,, $307.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Legionella Antibody,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lyme Disease Antibody,,,,, $516.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mhatp,,,,, $326.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mitochondrial Antibody,,,,, $413.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mono Test,,,,, $147.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mumps Antibody,,,,, $765.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Antibody,,,,, $424.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pneumococcal Abs,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pooz Echinococcus,,,,, $60.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Processing Autologous,,,,, $719.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ra Titer,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rh Phenotyping,,,,, $161.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rotavirus,,,,, $569.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rubella Igg,,,,, $319.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rubella Specific Igm,,,,, $319.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rubella Titer,,,,, $228.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scheroderma Antibody,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroglobulin Antib,,,,, $752.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toxoplasma Igm,,,,, $405.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Varicella Igg,,,,, $235.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Varicella Igm,,,,, $235.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rubeola Titer,,,,, $132.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vorl-Csf,,,,, $182.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody ID,,,,, $147.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Screen,,,,, $112.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crossmatch is,,,,, $79.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antithrombin Iii As,,,,, $771.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apc Resistance,,,,, $258.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aptt,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Automated Platelet Count,,,,, $102.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bleeding Time,,,,, $177.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CBC Complete Automated,,,,, $61.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coagulation Time Activ,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D Dimer,,,,, $517.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,D-Dimer Quantitative,,,,, $195.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eosinophil Count,,,,, $181.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor 8 Level,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor Ix Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor V Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor X Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor Xi Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor Xii Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Factor Xiii Clotting,,,,," $1,137.38 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fibrinogen Activity,,,,, $262.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hematocrit,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hematocrit Spun,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemoglobin,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kleihauer-Betke,,,,, $59.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Morphology,,,,, $520.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Aggregation,,,,, $362.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Countaiuid,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Countimanual,,,,, $146.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Function Assay #1,,,,, $156.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Platelet Neutralization,,,,, $306.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein C Antigen,,,,, $987.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Protein S Total,,,,, $855.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PTT Practionated,,,,, $191.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rbc Count Only,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reticulocyte Count,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sedrate-Westergren,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,WBC Count Only,,,,, $112.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wnc Diff Only,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Af N Men A/Y,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Afb ID Direct Probe,,,,, $252.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aft Smear Only,,,,, $193.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ag N Men C/U,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clostridium Diff Tox,,,,, $712.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Anaerobic,,,,, $378.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Blood,,,,, $84.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Body Fluid,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Cath Tip,,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Chlamydia,,,,, $427.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Csf,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Fungus (Blood),,,,, $562.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Fungus (Skin),,,,, $562.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Gc Definitive,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Genital,,,,, $257.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Herpes Typing,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Non Urine ID,,,,, $81.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Nose,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Routine,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Sputum,,,,, $73.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Stool Routine,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Throat,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Throat or Nose,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Urine,,,,, $18.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Urine ID,,,,, $86.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Viral,,,,, $946.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Culture Wound Aerobic,,,,, $269.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fungus Smear,,,,, $30.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gram Stain,,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis C Quant,,,,, $250.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Herpes Virus Isol,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Histoplasma Antigen,,,,, $377.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,India Ink Prep,,,,, $111.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Influenza B by Dfa,,,,, $126.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Jc Virus by Pcr,,,,," $1,089.68 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Koh Prep,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Legionella Antigen Urine,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Malaria Smear,,,,, $228.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neutrophil Ab,,,,, $267.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ova and Parasites,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pinworm Prep,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Refacid Fast Culture,,,,, $63.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,RSV Rapid Test,,,,, $382.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sensitivity Mic,,,,, $46.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Strep Group A Antigen,,,,, $206.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,West Prep,,,,, $140.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cult Fungi Other,,,,, $109.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cult Grp B Strep,,,,, $605.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bile Urine,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bile Urine Auto,,,,, $53.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reducing Substance Urine,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Timed Volume Measurement,,,,, $63.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinalysis Macro Only,,,,, $79.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urinalysis Micro Only,,,,, $66.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Indirect Coombs,,,,, $9.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clinical Consult Limited,,,,, $208.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flow Cytometry,,,,, $577.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fna Evaluation,,,,, $204.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cytology Cell Block,,,,, $281.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Decalcification Procedure,,,,, $113.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pathology Consult In Surg,,,,, $815.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pathology Level I,,,,, $198.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pathology Level Ii,,,,, $244.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pathology Level Iii,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pathology Level IV,,,,, $313.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pathology Level V,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pathology Level Vi,,,,, $617.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Special Stain Group Ii,,,,, $120.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Special Stains Group I,,,,, $151.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Special Stains Group Ii,,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abdomen 2 Views,,,,, $380.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abdomen 3 Views,,,,, $490.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abdomen IV (Kub),,,,, $569.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abdomen IV Port,,,,, $496.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abdomen One View,,,,, $360.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ac Joints Bi,,,,, $393.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ankle Complete,,,,, $379.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Athrect Periph Artery,,,,," $5,771.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Barium Enema,,,,, $687.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Barium Enema Red Svc,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Barium Swallow,,,,, $138.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biliary Stone Extraction,,,,, $673.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Age Studies,,,,, $572.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Density Dexa,,,,, $633.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Survey Limited,,,,," $1,132.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Breast Needle Local,,,,," $1,336.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Breast Surgical Specimen,,,,, $262.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronchography Bi X&i,,,,," $1,106.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Clavicle Complete,,,,, $373.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diskographylumbar S&i,,,,," $1,339.84 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abdomen Complete,,,,, $568.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ankle 2 Views,,,,, $347.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elbow 2v Comp,,,,, $309.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elbow Min 3v,,,,, $366.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Embolization Therapy,,,,," $8,848.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Embolization Therapy S&i,,,,," $5,008.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hip Min 2v,,,,, $457.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foot Min 3 Views,,,,, $366.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Forearm 2 Views,,,,, $353.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand 2 Views,,,,, $294.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hip Operative Proc,,,,, $939.16 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Min 3 Views,,,,, $339.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hip Unilat 1 View,,,,, $314.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ercp Biliry Duct,,,,, $782.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Esoph With Video,,,,, $890.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Esophagus,,,,, $557.56 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eye for Fb,,,,, $387.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Facial Bone 3 Views,,,,, $558.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Femur Min 2views,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Film Copy X-Ray,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flouro More 1 Hour,,,,, $222.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoro Needle Placement,,,,," $1,069.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fluoro W/O Film,,,,," $1,467.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foot 2 Views,,,,, $361.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humerus Min 2v,,,,, $366.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ivp Retrograde,,,,," $1,017.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ivus Supervision S&i,,,,, $346.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee 3 Views,,,,, $413.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee Min 4v,,,,, $106.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mandible 1-3v,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mandible Min 4v,,,,, $545.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Neck Soft Tissue,,,,, $367.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nephrostogram,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Optic Foramina Exam,,,,, $690.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orbits 3 Views,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orbits 4 Views,,,,, $524.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Panorex,,,,, $302.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pelvimetry,,,,, $520.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renal Angio Bilat,,,,," $3,838.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renal Catheter Placement,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scapula (2 Views),,,,, $386.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scapula Complete,,,,, $386.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sella Turcica,,,,, $331.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoulder 1 View,,,,, $374.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sialography S&i,,,,, $601.02 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinuses <3 Views,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinuses 4 Views,,,,, $524.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinuses Waters View,,,,, $413.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skull 1-3 Views,,,,, $510.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skull Min 4v,,,,, $648.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Small Bowel Series,,,,," $1,602.72 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Thoracic 2v,,,,, $570.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sternum 1v,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sternum 2 Views,,,,, $426.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Subtraction Study,,,,, $163.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Svc,,,,," $1,161.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tmj Bi,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tmj Unilat,,,,, $439.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Toes 2 Views,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Upper Gi,,,,, $720.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Upper Gi W/Air,,,,, $746.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Upper Gi W/Kub,,,,, $835.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ureter Stent Placement,,,,, $561.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venography Caval Inferio,,,,," $1,009.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wrist 2 Views,,,,, $288.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xray Reading Outside,,,,, $128.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zygomatic Arch,,,,, $393.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,A/C Joints Bilateral,,,,, $205.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ankle Ap & Lat,,,,, $167.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Coccyx,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colon Barium,,,,, $504.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Colon Barium W/Air,,,,, $536.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cystogram S&i,,,,, $471.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elbow Ap & Lat,,,,, $161.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elbow Complete,,,,, $337.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Elbow Complete I/F,,,,, $337.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foot Complete,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foot Complete I/F,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Forearm 1 Joint,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Complete,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Complete I/F,,,,, $299.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hand Two Views,,,,, $95.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hip 2 Views I/F,,,,, $405.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hip Ini Limited,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hip Uni Two Views,,,,, $323.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Facial Bones Comp,,,,, $306.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Femur,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fingers,,,,, $198.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foot Ap & Lat,,,,, $176.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Humerus,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee 2 Views I/F,,,,, $307.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee Ap and Lateral,,,,, $172.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Knee Completed,,,,, $247.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kub,,,,, $239.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mandible Complete,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mandible Copl I/F,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mandible Limited,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mastoid Complete,,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nasal Bones Only,,,,, $209.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Os Calcis,,,,, $202.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pelvis 2 Views,,,,, $311.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pyelogram Retro,,,,," $1,762.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ribs Bilateral,,,,, $369.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ribs Unilateral,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sacroiliac,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sacrum,,,,, $311.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scapula,,,,, $216.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoulder 3 Views,,,,, $335.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoulder Compl I/F,,,,, $247.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Shoulder Limited,,,,, $163.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinuses Complete,,,,, $358.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sinuses Limited,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skull Complete,,,,, $405.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skull Complete I/F,,,,, $405.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skull Limited,,,,, $261.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Cervical Compl,,,,, $443.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Lumb Complete,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sternaclavc Jnts,,,,, $218.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sternum,,,,, $269.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tempmndublr Jnts,,,,, $269.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tibia and Fibula,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Upper Gi Series,,,,, $609.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venogram Unilateral,,,,," $3,111.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wrist Ap & Lat,,,,, $172.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wrist Complete,,,,, $247.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bladder Scan,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Contrast Xray Uniary,,,,, $151.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Foot Complete 3 Views,,,,, $387.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ip Ini Limited,,,,, $248.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orbit X-Ray,,,,, $318.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Aortic Arch,,,,," $2,463.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Carotid CPT,,,,," $2,179.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Renal Unilateral,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Retro Brachial,,,,," $1,313.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Visceral S&i,,,,," $1,442.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angiography Spinal S&i,,,,," $3,865.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplasty Periph Art,,,,," $4,492.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arthrography Hip S&i,,,,," $1,490.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arthrography Knee S&i,,,,," $1,246.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Artho Shoulder,,,,, $647.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aorta Abdominal,,,,," $4,554.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aortoram Abdominal,,,,," $1,210.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest 1 View I/F,,,,, $479.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Complate 4 Views,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Inspir/Exp,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Lat Decub,,,,, $438.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Pa 2 Views,,,,, $556.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Pa Single View,,,,, $522.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Port,,,,, $419.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest One View,,,,, $221.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Three Views,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chest Two Views,,,,, $278.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Imaging Spect,,,,," $3,400.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cisternography,,,,," $2,567.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liver Funct Study,,,,," $2,514.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Liver Scan (Spect),,,,," $2,047.92 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lung Perfusion,,,,," $3,400.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Lung Ventilation Scan,,,,," $1,928.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Parathyroid Scan,,,,," $1,275.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Scan White Blood Cell,,,,," $3,372.92 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Schilling Test W/Factor,,,,," $1,191.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Testicular Imaging,,,,," $1,714.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tumor Local Spect,,,,," $2,794.16 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tumor Local Whole Body,,,,," $2,575.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastric Emptying Scan,,,,," $5,148.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastrographin Liquid,,,,, $434.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Chest W/Con,,,,," $4,525.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Pelvis W/Con,,,,," $4,325.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Facial W/O,,,,," $1,693.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Head W/Contrast,,,,," $1,585.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Head W/O Contrast,,,,," $2,163.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Iac W/O Cont,,,,," $3,239.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Neck W/Contrast,,,,," $2,894.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Crystal Analysis,,,,, $14.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Abd W/Con,,,,," $2,140.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Abd W/O Con,,,,," $1,507.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Guided Needle Loc,,,,," $2,268.40 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Needle Bx,,,,," $3,383.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Extremity CPT,,,,, $961.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Peripheral CPT,,,,," $5,450.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Renal,,,,," $3,396.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angio Visceral CPT,,,,," $1,352.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplasty Iliac,,,,," $4,492.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aorta Catheterization,,,,, $934.92 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aortogram Abd CPT,,,,," $2,316.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Appl Unna Boot,,,,, $419.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherect Aorta Surg,,,,," $2,958.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Lung,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronchography Uni S&i,,,,," $1,029.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bx of Kidney CPT,,,,, $952.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Central Venous Cath,,,,, $289.38 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Embol Extracranial CPT,,,,," $4,369.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Embolization CPT,,,,," $4,369.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ercp Radiology CPT,,,,," $1,675.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,I&d Cyst Complex,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,I&d Cyst Simple,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ins Chest Tube,,,,, $642.36 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insert Central Line Percu,,,,," $2,097.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Replc Picc Only Surg,,,,," $2,452.84 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reposition Leads,,,,," $3,916.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skin Biograft,,,,," $1,718.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Skin Biograft Add-On,,,,," $1,467.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Split Skin Graft,,,,," $3,782.08 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Stent Placement,,,,," $2,622.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thoracentesis,,,,, $804.54 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tissue Graft Other,,,,," $2,234.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tracheostomy Planned,,,,," $3,892.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,General Anesthesia,,,,," $2,207.98 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Blood Admin,,,,, $213.06 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Transfuse Blood Products,,,,, $719.74 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Echo Routine,,,,, $768.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ultrasound Extremity,,,,," $1,598.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Renal Sonogram,,,,," $1,749.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mammogram Special,,,,, $117.66 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Echo Color Doppler,,,,, $703.84 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Echograhy Transrectal,,,,, $858.60 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Abdomen Complete,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Abdomen Limited,,,,, $892.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Aorta,,,,," $1,011.24 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Breast Bilateral,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Breast Uni,,,,, $485.48 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Gallbladder,,,,, $675.22 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Kidney,,,,, $892.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Pelvic Complete,,,,," $1,069.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Pelvic Limited,,,,, $977.32 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Retro Limited,,,,, $838.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Scrotum,,,,, $747.30 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Thyroid,,,,, $711.26 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Transvaginal,,,,, $749.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Us Chest,,,,, $946.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Us Guide Vascular Access,,,,," $1,134.20 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Us Kidney,,,,, $946.58 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Abg,,,,, $208.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accapella Setup,,,,, $91.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Accapella Treatment,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Arterial Puncture,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronch Ther-Initial,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronch Ther-Subs,,,,, $228.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronch With Biopsy,,,,," $1,828.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bronch With Brushing,,,,," $1,620.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Cpr-Code Blue,,,,, $392.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Diag Bronch,,,,," $1,286.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Intubation,,,,, $327.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mdi Setup,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mdi Treatment,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxygen Per Day,,,,, $359.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxygen Setup,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Patient Education,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peak Flow,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pft Pre & Post,,,,, $228.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pft Simple,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulse Ox Setup,,,,, $72.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rt Assessment,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sputum Induction,,,,, $65.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suction,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suction Set Up,,,,, $105.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Updraft Set Up,,,,, $97.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Updraft Treatments,,,,, $86.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Vent Check-Daily,,,,, $32.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPAP,,,,, $392.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,CPAP Mask,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mdi,,,,, $73.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Non Rebreather,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxygen Mask,,,,, $10.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Suction Equip Daily,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Portable O2,,,,, $18.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulse Oximeter,,,,, $268.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Prosthetic Training 15min,,,,, $155.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Massage,,,,, $76.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Re-Eval,,,,, $90.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Therapeutic Proc,,,,, $56.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT-E-Stim,,,,, $78.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT-Wheelchair Main,,,,, $39.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sensory Integration 15min,,,,, $138.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Gait Training 15 Min,,,,, $271.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Kinetic Excercises,,,,, $92.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Evaluation,,,,, $98.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Therap Group 15 Min,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Physical Ther. Activities,,,,, $425.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Physical Therapy Procedures,,,,, $212.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Evaluation/-Go,,,,, $252.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Adl 15-Min,,,,, $182.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Re-Eval - Go,,,,, $211.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Tens Application - Go,,,,, $206.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Speech Therapy,,,,, $308.46 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Speech Therapy Eval,,,,, $484.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Swallow Clinical Eval,,,,, $854.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Echo 2d&m Complete,,,,," $1,639.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Echo D&m Limited,,,,, $378.42 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Echo Cardiogram,,,,," $4,562.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Ambulance One Way,,,,," $1,214.76 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Abd W/Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Brain W/Cont,,,,," $5,235.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Add'l Levels,,,,, $835.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,MRI Head,,,,," $3,007.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mra Head Wo Cont,,,,," $1,312.28 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,General Recovery,,,,," $1,500.00 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EKG,,,,, $216.24 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EKG Rhythm Strip,,,,, $94.34 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Electrocardiogram,,,,, $191.86 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EEG Sleep Only,,,,," $1,587.88 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Mslt,,,,," $4,470.02 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polysomnography W CPAP,,,,," $2,097.74 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polysomnography W/4+param,,,,," $5,587.26 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EEG,,,,, $960.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Hemodialysis,,,,, $549.08 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Peritoneal Dialysis,,,,, $720.80 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Nursing Assessment,,,,, $500.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Patient Education Group Sessio,,,,, $390.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Educational 60 Mi,,,,, $500.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Training Education 45 or More,,,,, $326.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 ", $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Tcp02,,,,, $503.50 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,EMG Electromyograph,,,,, $960.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Wellcare,Wellcare Medicare Managed,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $-   , $-   , $-   ,,,With the exception of professional charges all  Inpatient services included in the DRG Plan price.
Aetna,Commerical,DRG,,Private Room,,,,," $1,083.00 ", $-   , $-   ," $1,300.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Aetna,Commerical,DRG,,Semi-Private Room,,,,," $1,051.00 ", $-   , $-   ," $1,300.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Aetna,Commerical,DRG,,ICU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,500.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Aetna,Commerical,DRG,,CCU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,500.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Aetna,Commerical,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ", $-   , $-   , $-   ,,,Not included in contract
Aetna,Commerical,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ", $-   , $-   , $-   ,,,Not included in contract
Aetna,Commerical,HCPC's,90832,Individual Psychotherapy 30 Mi,HCPC's,90832,Individual Psychotherapy,, $250.16 , $-   , $-   , $-   ,,,Not included in contract
Aetna,Commerical,HCPC's,90834,Individual Psychotherapy 45-5,HCPC's,90834,Individual Psychotherapy,, $501.38 , $-   , $-   , $-   ,,,Not included in contract
Aetna,Commerical,HCPC's,90853,Group Psychotherapy,HCPC's,90853,Group Psychotherapy,, $326.00 , $-   , $-   , $-   ,,,Not included in contract
Aetna,Commerical,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ", $-   , $-   ," $123,000.00 ",,,Dailey Per Diem Avg LOS 82 days Pro Fees not included
Aetna,Commerical,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ", $-   , $-   ," $20,800.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Aetna,Commerical,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ", $-   , $-   ," $33,000.00 ",,,Dailey Per Diem Avg LOS 22 days Pro Fees not included
Aetna,Commerical,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ", $-   , $-   ," $40,500.00 ",,,Dailey Per Diem Avg LOS 27 days Pro Fees not included
Aetna,Commerical,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ", $-   , $-   ," $46,500.00 ",,,Dailey Per Diem Avg LOS 31 days Pro Fees not included
Aetna,Commerical,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ", $-   , $-   ," $20,800.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Aetna,Commerical,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ", $-   , $-   ," $45,000.00 ",,,Dailey Per Diem Avg LOS 30 days Pro Fees not included
Aetna,Commerical,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ", $-   , $-   ," $52,500.00 ",,,Dailey Per Diem Avg LOS 35 days Pro Fees not included
Aetna,Commerical,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ", $-   , $-   ," $63,000.00 ",,,Dailey Per Diem Avg LOS 42 days Pro Fees not included
Aetna,Commerical,DRG,,Interrupted Stay,,,,, $-   , $-   , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Code Blue,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peg Tube Placement,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perfusion 1 Hour,,,,, $369.94 , $369.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Picc Line Insertion,,,,," $2,855.64 "," $2,855.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debride Skin Full,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debride Skin Partial,,,,, $351.92 , $351.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 , $652.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 , $620.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 "," $1,240.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulsed Lavage,,,,, $184.44 , $184.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wound Care,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitiamin D 600 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,0.9% 10ml Flush,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,1eppra 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,250ml Bolus Ns,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,A&d Ointment,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 "," $3,051.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 "," $3,244.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abreva Cream 2gm,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accuzyme Oint 30gm,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acebutolol 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen 500,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen 650mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen/Codeine,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetazolamide 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetazolamide 500mg,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acyclovir 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acyclovir 500mg Inj,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acyclovir Oint 5gm,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acyclovir Susp 200mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adenosine  6mg Syri,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aggrenox 25/200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albumin 25gm 100ml,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albumin 25gm Vl,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 0.083% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol Inhaler 8,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 , $745.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allegra D 24hr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allopurinol 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alosetron 1mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alphagan 0.2% Drops,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alteplase Vl 1mg,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amikacin 500mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 , $374.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 "," $1,026.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin 1gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin 2gm Inj,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 "," $1,176.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anucort-Hc 25mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aquacel  With Transparent Film,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aquaphor Oint 3oz,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 "," $2,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 , $585.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aspirin 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atenolol 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atropine 0.4mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atropine 1mg Syringe,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Augementin Xr 875mg,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aveeno Bath,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacitracin Oint,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 "," $1,595.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Beer 12oz Can,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benicar 40/12.5mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benzocaine (Oragel),,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Black Widow Antiveni Vl,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 "," $3,169.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bss Irr Soln Sol,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 , $508.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Tab : 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Captopril Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 "," $4,211.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carmex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 "," $2,205.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celestone Mdv : 6mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cetaphil Mois Lot,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 , $314.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Charcoal Liquid  25gm,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cipro 500mg Tablet,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Citrical D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 , $169.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 , $245.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 , $308.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Combigan Liquid 5ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Combivir Tablet,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Copaxone 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coumadin 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coumadin 7.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 "," $7,094.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 "," $1,566.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D10 W,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D50w 50ml Injection,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 , $452.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Danazol Cap : 200mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dapsone 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 "," $1,214.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 "," $1,057.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 "," $1,850.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 "," $1,451.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 "," $5,808.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 , $727.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 "," $1,162.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Destroxe 70% 500ml,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 10% 1000mls,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 20% 500ml,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 5% 100ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose Amp : 0.1,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 , $227.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 "," $1,568.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilacor Xr 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem 180,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dipentum Cap : 250mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 , $215.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 "," $8,438.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 "," $2,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 "," $6,604.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 "," $1,651.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 , $954.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 , $446.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 , $178.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 , $357.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ephedrine 50mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epidrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 "," $1,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 "," $1,591.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 , $921.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 , $776.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epogen 1000 Units,,,,, $904.00 , $904.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 , $614.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 "," $3,354.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 "," $1,225.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 , $512.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 "," $1,602.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythromycin 500mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 "," $1,201.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estrogens Esterified (Menest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Etodolac Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Etoposide Vl : 10mg,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 "," $1,195.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 "," $1,113.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 , $280.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrex 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flanders Butt Oin,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fleet Prep Kit #3,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 , $130.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 , $426.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 , $148.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 , $394.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 , $653.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 "," $1,015.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folic Acid 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide Xl 10mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucagon 1mg Inj,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucosamine 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Gel,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucovance 5/500,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycerin Adult Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycerin Pediatric Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycerin Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 "," $7,368.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 "," $1,020.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guiatuss Dac Syr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Halothane Liquid 250ml,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heparin Antibody,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 , $391.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 , $584.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 "," $1,681.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Icy Hot Cream Cream :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 "," $3,165.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indomethacin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 "," $3,652.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Glargine (Lantus),,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intralipids 20% 100ml,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 , $492.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 "," $1,797.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isentress 400mg Tablet,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Dinitrate,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 "," $1,273.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketamine 100mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lantus 100 Units/ML,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 "," $1,045.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levemir 100 Units/ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lice Comb Ea,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lindane Shampoo 60ml,,,,, $681.00 , $681.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 , $622.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 "," $2,385.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorcet 10/650,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorcet Plus,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 5,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 , $272.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 "," $1,213.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maalox,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magic Mouthwash,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Citrate 8oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Marinol 2.5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maxzide 50/75,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meclizine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace 400mg/10ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Melatonin 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Melatonin 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mepilex,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 , $838.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Merrem 250mg Ivpb,,,,, $690.00 , $690.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methadone 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methimazole Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metronidazole 500mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 "," $1,192.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 , $234.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miochol E Sol : 0.01,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mivacurium Inj 2mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mvp,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mysoline 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nabumetone 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nacl .9% 250ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nadolol 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naprosyn 500mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 "," $3,134.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 "," $1,073.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 "," $2,090.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 , $510.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norcuron,,,,, $886.00 , $886.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 "," $2,522.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin R 100 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolog,,,,," $2,822.00 "," $2,822.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns 1000ml Bag,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns 100ml Bag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns 250ml Adv Bag,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns 250ml Bag,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns 50ml Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns Irrigation 3000ml,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns Plus 100ml Bag,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns Plus 50ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Cream 15gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 , $449.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 "," $1,599.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 "," $1,524.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peg Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 "," $8,933.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 "," $1,999.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pentasa 250mg Capsule,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Petrolatum White Oin,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pindolol Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 , $435.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polycitra Lc Sol,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Premarin 0.625 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prenatal Vitamin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Preparation H Ointment,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Progesterone Microni (Prometri,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 "," $1,389.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protamine 50mg Amp,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 , $409.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinine 325mg Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 , $751.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 , $732.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Refresh Tears 15ml,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renagel 800mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 "," $1,694.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 , $575.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rifampin 300mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 1mg/1ml,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 , $775.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rocaltrol .25mcg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Salsalate Tab : 750mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Silver Nitrate Stick,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 "," $1,455.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 , $275.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 "," $1,622.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sorbitol 70% 30ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 , $484.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Starlix 120mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Water 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Streptomycin 1gm Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 , $288.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulindac Tab : 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulindac Tab : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Surgilube Oin : 60gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Symmetrel 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Symmetrel Syr 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 0.05mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tekturna 150mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 "," $7,624.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 , $344.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 , $685.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetracycline 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 , $560.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thrombin 5000 Unit,,,,, $937.00 , $937.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid Tab : 1grain,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 , $377.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 , $617.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin 300mg Inh,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin 80mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 , $322.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 , $419.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 "," $5,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trace Elements 5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trental 400mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 , $694.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tricor 48mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urogesic Blue Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 "," $1,023.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin 1gm Vl,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin 500mg Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vasopressin Vl : 20units,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vecuronium 10mg Inj,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil 240 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil Tab : 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vfend 200mg Tablet,,,,, $764.00 , $764.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 "," $2,499.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Viread 300mg Tablet,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vistaril 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin A 10mu Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $702.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc 10mg Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc 220mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc Oxide Ont,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $402.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 "," $1,332.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $595.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accucheck,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,A/B Otic Drops,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 15 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 30 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 5 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acarbose 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accolate 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accupril 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acidophillus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aciphex 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Actonel 35 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Actos 15 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Actos 30 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Actos 45mg,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advair,,,,, $408.00 , $408.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advair Discus 250/50,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advair Diskus Inh,,,,, $819.00 , $819.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advanced Eye Relief,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advil 200mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aerobid,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aerochamber,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aggremox Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aggrenox ER Caps,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Akwa Tears,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aldactone 25mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alendronate 35mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alendronate 70 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aleve,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Align,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allegra 180 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allegra 600 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allegra-D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Altace 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Altace 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amaryl 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amaryl 4 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ambien 10mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ambien 5mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ambilify 10 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amblify 15 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlopidine-Benaz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anafranil 25 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Analgestic Creme Rub,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anaspaz Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antacid Susp Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antioxidant Vitamins,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anusol Hc Supp,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arimidex 1 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Asacol 400 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ascensia Elite #50,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Asmanex Twisthaler,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aspercreme 10%,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Asprin 81mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atacand 16 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atacand 32 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atarex 25mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atenolol 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atenolol 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ativan 1mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ativan 2mg/ML,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atrovent Inhalation,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atrovent Inhaler,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avandia 2mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avandia 4mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avapro 150mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avelox 400mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azo Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,B-1,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Baclofen 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bactrim Ds,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $401.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benadryl 25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benadryl 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benicar 20mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benicar 40 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benicar 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztrop 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztropine 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betapace 80 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bethameth Driprop .5,,,,, $499.00 , $499.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bethanechol 50mg,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biaxin 500 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisacodyl 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biscolax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisoprolol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Black Cohosh,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blistex Lip Medex,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Boniva Tab 150,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Boost,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bumex 1mg,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspar 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspar 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspirone 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspirone 15 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspirone 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspirone 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bystolic 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calan 120 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calan Sr 180mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium 600+d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Carbonate 60,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Caltrate 600 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Campral 333 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Capoten 25mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Captopril 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Captoril 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazepine 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazepine 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardina 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardura 2 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cecon Bottle,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftin 250mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celebrex 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celebrex 200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celexa 20 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cellcept 250mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Centrum Silver Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Century 50 Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Century Senior Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cepacol Lozenges,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlestyramine Packet,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chloraseptic Spray,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorex-A Tablets,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorophyll 3mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorpromazine HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholestyramine Packs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Citalopram 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Citalopram 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Citalopram 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clarinex 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Claritin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cleocin 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clobenzaprine HCL,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine .2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrim Antifungal,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clozaril 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cogentin 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cogentin1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Col-Benemid,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Combigan Eye Drops,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Compazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Compound Rx 30gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Comtan 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Copaxone 20mg,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cordarone 200mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Corgard 40mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Corge 12.5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Corona Ointment,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Correc Cr 40mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cosopt Eye Drops,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coumadin 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cozaar 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cozaar 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cozaar 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crestor 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cymbalta 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cymbalta 30mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytra K 5ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darvocet N 100mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darvon 65mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depo Provera,,,,, $729.00 , $729.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desipramine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desyrel 100mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Detrol La 4 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diabeta 5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diclofenac Sod,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diflucan 150 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin 250mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin 50mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem ER 120,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan 160 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphedryl Sod,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divan 40mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Docusate Calcium,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Donnatel/Maalox,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxazosin Mesylate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxycycline 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dss 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dss W/Casan,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dulcolax,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duoneb 2.5,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dyazide,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dynapen 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dytan 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Effexor Xr 150mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Effient 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elavil 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $235.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elnorm 6mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril Maleate,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 "," $1,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Esidrix 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eskalith Cr,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estazolam 1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estropipate 0.625,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Etodolac 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,E-Vista 60 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Evoxac 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exelon 3mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exelon 6 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exforge 5 320mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eye Stream 30ml,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Famotidine 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Felodipine ER 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Femera 25mg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feosol,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fergon,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fexofenadine HCL,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fiber Laxative 625,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fiber Powder,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fibercon 500mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fibercon 625 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Finasteride 5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fioricet 1 Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flagyl 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flonase Nasal Spray,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $230.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flu Vaccine,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fludrocortisone Ace,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoprazine 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flurazepam,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluticasone 50mcg,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluzone,,,,, $237.00 , $237.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folamin Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foltx Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fortical Nasal Spray,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fosamax 70 Mg,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fosinopril/Hctz,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabitril 12mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Genasyme 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Genebs 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Genteal Drops,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 20 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $654.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 80 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geritol Complete,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucophage 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucotrol 5mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucovance 2.5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycolax 255 Gram,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glynase 3mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guanfucine 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 5 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 5mg/ML,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol ML 120,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hcts 1% 30gm,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humalog Ins Inj,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humulin 70/30,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrea 500 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hypotears Eye Drops,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hytrin,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,I Caps Plus,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Imdur 30 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immitrex 50 Mg,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immodium 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inderal 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inderal 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inderal La 120 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inspra 25 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Humulin R,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Invega 3 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isopto Tears,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isordil 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Nacl,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Januvia 50 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Jevity 1.5,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Juven,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K Dur 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keflex 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keflex 500mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kenalog,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $461.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keppra 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Klonopin 1 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Konsyl Powder,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Labetalol HCL,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactaid Fast Act,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamictal 100mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamictal 150mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamictal 25mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lantus Insulin 100,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lantus Insulin Inj,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Latuda 40 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Laxative Suppository,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lecithin 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lescol 20 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lescol Xl 80mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levaquin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levaquin 500mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levemir Vl,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothroid .05 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothroid 0.125,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothroid 75mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroid 25mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levthyroxine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lexapro 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lexapro 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Limbrel 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lioresal 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipitor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipitor 20 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipitor 40mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lodine 500 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lofibra,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lomox Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loniten 2.5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loperamide Hci Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lopid 600 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lopressor 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loratadine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab-5,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotensin 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovastatin 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovaza 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovenox 40mg,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loxitane 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lumigan Eye Drops,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lunesta 1 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lunesta 2 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lunesta 3 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lyrica 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lyrica 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lyrica 300 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maalox 0,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Macrobid 100mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mag Ox 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Citrate,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Oxide 241,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mavik 1 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maxzide 75/50,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medrol Dose Pak,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Susp. 5ml,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mephyton 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metaformin 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metamucil Pkt,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin 1000 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin 850 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin HCL 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methadone HCL 10mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methotrexate 25mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoclopramide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoclopramide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metolazone 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Succ,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mevacor 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miacalin 200u Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mi-Acid Gas,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Micardis 40 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Migrazone Capsules,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Minocin 100mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miralax Packet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miralex 255 Gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Moban 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Moban 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Monopril 20mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Motrin 120ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Motrin 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Motrin Susp 5ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucinex 600 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multigen Plus Caplet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multivitamin With Mineral,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Murine Tears Plus,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mylicon 80,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nadolol 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Namenda 10mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Namenda 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naphcon-A 5ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen 250 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen 500 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen Sod,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasacort Aq,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasal Solutions,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $557.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nature Tear Drops,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Navane 5 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nb Valerian Root,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neosporin Ung Pk,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neurontin 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neurontin 300 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nexium 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nexium 40 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Niacin 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nifedipine 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Niferex 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nilandon 150 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroquick,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norco 10/325 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norpramin 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norvasac 5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norvasc 10mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin 70/30,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin R 100 Units,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolog Mix 70/30,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Occuvite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Omacor 1 Gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Omnicef 300mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,One A Day,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,One-A-Day Mens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Opana ER 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orajel,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orap 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Os Cal 500d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Osteo Bi Flex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxytrol Patch,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oyster Shell Calcium,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pancrease Ec Caps,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil 20 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil Cr 12.5,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pepcid  Complete,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Periactin 4 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peridex 473ml Sol,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perparation-H Ointment,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perphenazine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan Supp,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytek 300mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pindolol 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plaquenil 200mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plavix 75mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pletac 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pletal 100mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potass Cl Meq,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravachol 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravachol 20 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravachol 40 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Precose 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisolone Acetate,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prelone 5mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Premarin Vag Cream,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Preservision Softgel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prevacid 15mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prevacid 30mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prevastatin Sod,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prisolec Otc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pristiq 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 "," $1,002.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 "," $1,815.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine Supp,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proscar 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prostate Formula,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protocream Hc 30gm,,,,, $440.00 , $440.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protonix 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protonix 40mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Provera 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Provigil 200 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prozac 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prozac 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyridoxine 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Questran Pckt 9g,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinapril 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinapril 20mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinapril 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinidine 200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ramipril 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rampipril 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranexa 500 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rapamune 1 Mg,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Razadyne 12 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Razadyne 8 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Refresh Eye Drops,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Relafen 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Remeron 15 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Remeron 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Remifemin Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reminyl 12mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip .25 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip 1mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Restoril 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rezadyne 4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rhinocort Agua,,,,, $378.00 , $378.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $932.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 1mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 2 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 4 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $946.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperidone .25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperidone .5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperidone 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperidone 4 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ritalan 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Robitussin 5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Robitussin Dm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole .25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole HCL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rozerem 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Saphris 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Saphris 5 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senna Gen Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senna Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sennalax-S Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senokot 187mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Septra Ds,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Serevent Disl Inh,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroguel 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 300 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Serzone 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shopax 100 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinemet 25/100,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinemet 25/250,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Singulair 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skelaxin 800mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slow Fe 160mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slow K-8 Meq,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sonata 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sonata 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spiriva 18mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spiriva Handihaler,,,,, $429.00 , $429.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spiriva Refill,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $660.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ssystane Eye Drops,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ST John's Wart,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Starttera 40 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stool Softner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Strattera 25 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stress W/Zinc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sumatriptan Succ,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Super Thera Vite Mt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Symbicort 80 4.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Symbyax 6/25mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Symmetrel 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid .05 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid .2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tamoxifen 10mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tapazole 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tarka 2/240,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tears Pure,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegretol 200mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tekurna 150 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Temazepam 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Temazepam 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tenex 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tenormin 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tenormin 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terazosin,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terazosin 5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terbinafine HCL 250,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theo-24 200 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theo-Dur 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theophylline 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theragran M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Therapeutic M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thermotab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiamin 50 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiamine 100 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid 2 Gr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tofranil 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tofranil 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topamax 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topiramate 100 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toprol Xl,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Torsemide 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Torsemide 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Traqzadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazadone 150 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tricor 145mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trileptal 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trilipix 45 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trimpex 100 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tums 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tussin Cough 8oz,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uloric 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ultracet 37.5/325,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ultram 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uniphyl 400mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Univasc 15mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urecholine 25mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uroxatral 10mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vantin 200 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vasotec 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vasotec 5mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil 180 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vesicare 5mg,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Viactiv Chew Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vicon C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vigamox Drops,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Visken 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin A,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B-1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D 400 U,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Volaren 1% Gel,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Voltaren 75mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Water 45 M,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Welchol 625 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Women's One A Day,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xarelto 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Z0cor 20mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zanaflex 4mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zantac 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zelform 6 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zestril 10 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zestril 20mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zestril 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zetia 10 Mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ziac 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc 50mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc Gluconate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zithromax 250 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zocor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zocor 40mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zocor 80 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zofran 4mg Tab,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zoloft 100 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zoloft 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zoloft 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zolpidem Tartrate,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zonegran 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zonisamide 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zovirax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyloprim 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyloprim 300mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 15mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexia 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyrtec 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 2 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acamprosate Calc 333,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accupril 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accupril 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accupril 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accuzyme Oint,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $559.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $632.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adderall 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adderall 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advair Diskus 100/50,,,,," $1,128.00 "," $1,128.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advair Diskus 500/50,,,,," $1,855.00 "," $1,855.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advair Hfa 115/21,,,,," $1,391.00 "," $1,391.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advil Congest Rel,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Advil Pm,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Afrin  .05 Spr,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alaway Eye Drops,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 2mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol Inhaler,,,,, $293.00 , $293.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aldactone 50 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alendronate 35 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aleve 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allegra 60 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allopurinol 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $460.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Altace 1.25 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Altace 10 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amaryl 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $613.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amikacin 500 Inj,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlactin Lotion,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amloride 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin 500mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anikacin Inj 250,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apresoline 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 "," $1,656.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arava 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aripiprazole 15mg,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Armour 90 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aromasine 25 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Artificial Tears,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $742.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aspercreme,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Astelin Nasal Spray,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atacand 8g,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atenolol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ativan 0.5 Im,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 "," $1,242.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $711.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Augmentin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avandia 8 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $733.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ayr Nasal Mist,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azilect 1 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azmacort,,,,, $607.00 , $607.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azopt Drp 1%,,,,, $482.00 , $482.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Azor 5/40 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacid Capsules,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Baclofen 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Baclofen 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Baclofen 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacmin Tab 1,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $680.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bee Pollen,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benadryl Crm 2%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benicar 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benztropine 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betamethasone Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betoptic S Ophth,,,,, $480.00 , $480.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 "," $1,129.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biotene Mouthwash,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisacodyl 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brimonidine 0.2%,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brintellix 10 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 "," $1,086.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bystolic 10 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bystolic 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calan 80 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcarb 600 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitrate 600 + D,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Carb 600mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calmoseptine Pks,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Caltrate 600 Plus,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardizem 30 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardizem 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardura 1 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardura 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carmex Lip Ointment,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Casodex 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefpodoxine 200,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftin 500 Mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cefzil 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celestone 2 ML Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celexa 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celexa 15 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celexa 40 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cellurisc 1%,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Century Senior Vitamin,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Century Vite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cepacol Throat Spray,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cephalexin Monohydra,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cerefolin,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cerefolin Nac,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cetaphil 80z,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chantix .5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chantix 1 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholestyramine Powder,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chromagen Forte,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chromium 200 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $683.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Citracal Petites,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Citrucel Each Scoop,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clarithromycin 500mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Claritin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin Oint,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $385.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine 0.1,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $447.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $349.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole 1%,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clozapine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clozaril 100 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clozaril 50 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clozipine 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clozipine 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cogentin 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colace 100mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colace 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colcrys .6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colon Clenz Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $621.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Combivent Respimat Inh,,,,," $1,335.00 "," $1,335.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Complex + Msm,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coq-10 200 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coreg 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coreg 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coreg 40 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cortef 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $436.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coumadin 6 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Creon Dr 3000 U,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crestor 20 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crestor 40 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crestor 5 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytomel 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dantrolene Sodium,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Decadron 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Delsym Each Tsp,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote 1000 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote 1500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote 750 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Deplin 15 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desipramine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desloratadine 5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Desonide Lot 0.05,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexilant 30 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dexilant 60 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dextrose 50% Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diamox 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diary Digest,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diatx Tab 1,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diflucan 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diflucan 200 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin 0.1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin 0.25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $243.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin 200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin 400 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan 320 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diovan 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ditropan 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ditropan 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Docusate Calcium 240,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $121.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin 75 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duleek Met,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dulera Inhaler,,,,," $1,241.00 "," $1,241.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duoneb 3ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ear Wax Drps,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Effexor 225 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Effexor 50 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elavil 100 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $506.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elimite Cream 5%,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eliquis 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elmiron 100,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enablex 15mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril Maleate 10,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enoxaparin 100mg,,,,, $583.00 , $583.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Entacapone 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Entacort .25 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epoetin Alfa,,,,," $4,247.00 "," $4,247.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estroven Weight Mgt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Etodolac 100mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Etodolac 400 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ex-Lax,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fanapt 1 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fanapt 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fanapt 4 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Felcainide 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feldene 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Felodipine 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fenofibrate 145mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feogen Ga,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fergon 27 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fergon 324 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flagyl 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flecainide 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flector 1.3% Patch,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flexeril 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flexeril 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Florajen Acidophilus,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Floranex Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Florastor 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flovent Hfa,,,,," $1,507.00 "," $1,507.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $625.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folacin B/6/B12,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folbee Vitiamn,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folbic,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foltanx 90 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foltrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $284.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Freshkote Eye Drps,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Furosemide 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fycompa 8 Mg,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabitril 16 Mg,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabitril 6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabitril 8 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gas X 180 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gaviscon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 10 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 10mg Injection,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 30 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glcagon Inj,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide 15 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glipizide 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucophage 250 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Tablets,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide 3 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gs Century Vits,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $58.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gynalotrimin,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hematogen Capsule,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemocyte Plus,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hum Benzoin Compound,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocort 2.5%,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $684.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,I Car-C Plus Sr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,I Vite,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Icaps M/V (Eye),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Imdur 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Imipramine 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inderal 25 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indocin 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indomethacin 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insta Glucose Gel,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Instaflex Joint Support,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Integra Vit,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 "," $2,076.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Invokana 100 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Jantoven 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Januvia 100 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Januvia 25 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,J-Tan D Sr,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K Clor 8 Meq,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K Dur 20 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K Dur 30 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K Dur 40 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K Phos,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 10 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kcl 8 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keppra 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keppra 750 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Klonopin 2 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Klor Con 10 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Klor Con 20 Meq,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Labetalol 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Labetalol 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lacrilube Oint,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactaid,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactinex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactulose 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamictal 200 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $171.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamisil,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamisil 250 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamotrigine 25mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lanacane Compound Oint,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Latuda 20 Mg,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Latuda 80 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $972.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levaquin 750 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levemir Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levemir Flexpen,,,,," $1,510.00 "," $1,510.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothroid .15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothryoxine 88mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lexapro 15 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lexapro 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lexapro 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Librium 5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipitor 80 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium Carbonate 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Livalo 2 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lodrane D24,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loperamide 2 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lopressor 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lopressor 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 2.5/500,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Losartan 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Losartan 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Losartan 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotemax Opth 5%,,,,, $657.00 , $657.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotensin 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotensin 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotensin 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loteprednol Drop,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovaza Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loxapine 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loxapine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $692.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lyrica 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lyrica 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lyrica 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maalox 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medical Food 1 Tab,,,,, $188.00 , $188.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace 60 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 "," $3,406.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megestrol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Melatonin .75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Melatonin 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Memantine HCL 10mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mestinon 60mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metafolbic Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metalozone 5 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metamucil Cap,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metanx 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin 250 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin 600mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methadone 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methadone 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metronidazole 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 "," $1,011.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Micardis 80 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midodrine 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Midrin Capsules,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Minipress 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Minocycline 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirapex 1 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mobic 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Modafinil 200 Mg,,,,, $47.00 , $47.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Monopril 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Montelukast 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine 15 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucinex D,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multaq 400 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multivitimine,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mylanta 15ml,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mylanta 30 Cc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mylanta Bottle,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mylicon 125 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nalfon 400 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naprelan 375 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen 375 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen 550 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Narco 10/325,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Narco 5/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasal Crom Spray,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nauzene,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neosporin,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neurontin 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neurontin 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neurontin 800mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neurontin 900 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neutro Phos 250mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Niacin 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine Transdermal,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nisoldipine 20mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitrolingual Spray,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norco 5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norflex 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin 100units,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolog Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Novolog Flexpen,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuedexta 20/10,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $319.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ocean Mist,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ocean Nasal Spray,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ointment 120 Com,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 5mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Omeprazole 10mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Onfi 10 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Onglyza 5 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Opcon A Eye Drops,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Optive Eye Drops,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Os Cal 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Osphena 60 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone 5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paceron 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paceron 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pamelor 50 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pamelor 75 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pancrelipase 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pangestyme Ec,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pataday Eye Drops,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Patanase Nasal Spray,,,,, $535.00 , $535.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Patanol,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $774.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paxil 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pentazocine Nalox,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pepcid 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pepcid 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Percocet 3.75/250,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Percocet 5/325,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peri Colace,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Periactin 2 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phazyme 180 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenergan W Codine,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital 60mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phentermine 37.5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pioglitazone 30mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pioglitazone 45mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plagic 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plavix 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plendil 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plendil 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ployethylene Glycol,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pneumonia Vaccine,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Ch 10meq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Phos 250,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prandin 1 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravachol 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prazosin 1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prazosin 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prazosin 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 30 ML,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prednisone 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pregabalin 25mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pregabalin 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Premarin .9 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Premarin 0.3,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Premarin Cream 30g,,,,, $978.00 , $978.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Preparation H Supposority Box,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Preservision Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prevalite Powder,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prilosec 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Primidone 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Primidone 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pristiq 100 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proamatine 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proamatine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Probenecid Colchicicine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 "," $1,277.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $725.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $274.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prograf 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prometrium 100 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promod 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol 80 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prosight,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prostat 30 Cc,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Provera 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Provigil 100 Mg,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prozac 40 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $432.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prozosin 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Psyllium See Pack,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $656.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulmocare Nutrition,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyridium 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Qnasl Nas Spray,,,,, $700.00 , $700.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Questran 2 Gm,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Questran 9gm Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinidex 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Qvar Inhal,,,,, $825.00 , $825.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ramipril 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Refresh Pm Ointment,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 "," $4,243.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Remeron 45 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renvela 800 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip .125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip 0.5mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip 4 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Resperdol 1 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Restasis 0.5%,,,,, $815.00 , $815.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Restoril 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rifampin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risamine Oint,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $257.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal 6 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $766.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 "," $1,716.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 "," $2,250.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 "," $3,147.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperidone 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Risperidone 3 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ritalin 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ritalin 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ritalin 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rivastigmine 3mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Robaxin 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Saline Flush,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sam E 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sam E 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sanctura 20mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Santyl Top,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Savella 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Selenium Shampoo,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senna 8.6mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sensipar 30 Mg,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Serax 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 500 Mg,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel 75 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sertraline 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sertraline 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Silenor 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Silvadene Cream,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Silversulfadiazine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simethicone 80 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinemet 12.5/50,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinex Nose Spray,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Singulair 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sotalol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sotalol 80mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spiriva Inhaler,,,,, $444.00 , $444.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sporanox 100 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sps Suspension 60ml,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stalevo 100 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stalevo 150 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stalevo 50 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stalevo 75 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Starlix 60 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stelazine 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stelazine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $134.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sudafed 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sudafed 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sular 17 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sular 34 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sumatriptan 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sumatriptan 25mg,,,,, $427.00 , $427.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Surmontil 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 "," $1,384.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 "," $1,029.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tagamet 400 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tamiflu,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tapazole 10 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tapazole 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tarvatan Drops,,,,, $514.00 , $514.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tavist,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegretol 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegretol 300 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegretol 400 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tekturna 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tenex 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terazosin 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theophylline 400 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theraseal Hand Cream,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tiagabine 4mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ticlid 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tigan 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tinactin Spray,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobradex Eye Oint,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobradex Opth Drops,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $451.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topamax 200 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topamax 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topiramate  25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topiramate 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toradol 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toviaz 8 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trandate 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Travoprost Eye Drops,,,,, $538.00 , $538.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone 25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tricor 48 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trilafon 8 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trileptal 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trileptal 400 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trileptal 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trileptal 75 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trilipix 135 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trospium 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tums 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tums 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tums 650 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Turmeric Curcumin,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol 325 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol 650 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol Pm,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ultracet 100,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urecholine 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urelle Tablet,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uricholine 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urimar-T Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ursodiol 300mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valisone,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valium 5 Mg Im,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid 125mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid 500mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valsartan 160,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valsartan 320 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valsartan 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valtrex 500 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $238.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil 80 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vesicare 10mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Viamin B Complex Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Viamint E 200iud,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Victoza Epipen,,,,, $821.00 , $821.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Victoza Pen Bx,,,,," $2,143.00 "," $2,143.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Viibryd 40 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vimpat 100 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vimpat 200 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vimpat 50 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Visine Eye Drops,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vistaril 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B3 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Vitamin D 50,000",,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vivactil 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vivactil 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Voltaren 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Whey Protein Isolate,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xarelto 15 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xarelto 20 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $276.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xopenex Inhaler,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Z-Gen,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zioptan Eye Drops,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zithromax 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zocor 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zofran 8 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zoloft 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zoloft 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zolpidem Cr 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $982.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zpak 250 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyrtec 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zyvox 600 Mg,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Torsemide 5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Candesartan 8 MG,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orap 1 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $197.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Norvasc 5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CEROVITE SR TABS,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BUPROPION 75 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,venlafaxine 25 mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 "," $1,474.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VYVANSE 50 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $362.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $631.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 "," $1,062.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 "," $1,405.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $3.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $728.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ULORIC 80 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CREON 12000 U,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BRILINTA 90 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FUSION PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FOLBEE PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 "," $1,194.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LINZESS 145 MCG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LATUDA 60 MG,,,,, $144.00 , $144.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,INVOKANA 300 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VIMPAT 150 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DILANTIN 30 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PREPARATION H SUPP,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,REXULTI 1 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FARXIGA 10 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,REXULTI 2 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MELATONIN 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $816.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FETZIMA 40 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FETZIMA 80 MG,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NAPCON A SOL,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MELATONIN 0.5,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $787.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LIVALO 4 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 "," $1,538.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $193.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 "," $1,766.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $199.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FE C TAB 100,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mybetriq 25 mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $1.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $2.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $79.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AZOR 10/40 MG,,,,, $49.76 , $49.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LABETALOL 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 "," $2,517.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CREON 6000 U,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,REXULTI 3 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $20.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 "," $1,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $3.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $3.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $52.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $6.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $34.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $68.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ATRIPLA,,,,, $399.80 , $399.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $13.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $1.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $1.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $3.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $59.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $818.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $61.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $1.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $4.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $131.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $51.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $3.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $445.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $2.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arginaid Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $525.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 "," $1,992.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coban,,,,, $10.32 , $10.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Descovy 200 25 mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $291.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estroven 1 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lamicatal 200 mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lisinopril 15 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $51.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $33.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $7.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metoprolol 100 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $165.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebivolol 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pataday 2% (bottle),,,,, $594.00 , $594.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pataday 2% (drop),,,,, $19.80 , $19.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $3.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $11.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Primidone 150mg,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Propranolol 20mg,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Requip 3mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Salagen 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tivicay 50 mg,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toprol 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Torsemide 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tresiba (unit),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Warfarin 40mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zocor 20mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zocor 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zoloft 200mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zonisamide 75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Naproxen 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinemet 50/200mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $63.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $3.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $540.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tandem Plus Capsule,,,,, $6.96 , $6.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $28.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $2.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LATUDA 10 MG,,,,, $99.91 , $99.91 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MULTILEX,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $202.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $195.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $13.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $7.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $31.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $26.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $9.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $188.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $1.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LINZESS 290 MCG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $2.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $113.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $2.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $37.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $21.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $5.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $14.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $257.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $56.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $55.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $23.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $43.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $17.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 "," $1,548.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pentasa 500 MG,,,,, $29.32 , $29.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CENTRATEX,,,,, $4.48 , $4.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $11.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $5.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $9.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $55.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,REXULTI 4 MG,,,,, $184.68 , $184.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $8.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $148.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $2.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $58.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $8.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $6.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $172.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,SALSALATE 500MG,,,,, $71.22 , $71.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $100.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $34.17 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $48.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $81.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $15.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuplazid 34 mg,,,,, $304.74 , $304.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 "," $1,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $8.29 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $122.61 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Infusion Therapy,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 "," $2,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $421.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $844.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $231.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,10ml Control Syringe,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,14fr Stylet Slip,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,21 Lnr Ps,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $189.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,300cc Collection Canister,,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,48  Press Moniter Line,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adapter T,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Air Hose Disposable,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Air Hose Reusable,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alcohol Prep Pads,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Algidex Ag Gauze,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Reflux Filter,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antifungal Cream,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antireflux Filter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bacteria Filter,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Scissors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $38.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Surepress Compression,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Barrier Film,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bed Air 48,,,,, $119.78 , $119.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bed Air 48  Turning,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betadine Sol 8oz,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Betadine Swabsticks,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bite Block,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $359.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bottle 100ml Saline,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bp Cuffs Medium,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bracket  Mounting,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Bridge,suture Retention",,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brief Adult Large,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bucks Traction Boot,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calazime With Olivamine,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cannula Etc02,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Cap, Trach",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carafe With Straw,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $57.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter Connector,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter Connector (Blue),,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter IV,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter Stabilization Device,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Centerpointlock Pouch,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 "," $1,068.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Tube Tray,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Clamp, Beta",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Clamp, Occluding",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Cold Pack, Instant",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $27.15 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Commode Containers,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cone Finger Separater,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cooling Blanket,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Cover, Probe",,,,, $76.32 , $76.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $259.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cup Medicine,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debridement Tray Gss,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Del Clamp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digital Termometer,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dispo-A-Probe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Disposable Headstrap,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Disposable Lead Wires,,,,, $261.82 , $261.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drain Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $58.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dycem Matting,,,,," $1,064.24 "," $1,064.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Edema Gloves 1ea,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Expiratory Filter,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 "," $2,764.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flexiseal Bag,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flexiseal Management System,,,,," $2,640.46 "," $2,640.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $10.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Forceps, Adson",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Full Face Mask Large,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Full Face Mask Medium,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Full Face Mask Small,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gair Built Blue,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $323.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Geri Chair Cushion,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gloves Large Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gloves Medium Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucerna 1.2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hair Brush,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Pitt Padded,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemostat Absorbable,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,High Flow Humidification Syste,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hip Kit,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hot Packs,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrogen Peroxide,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $135.21 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ioban Steri Drape,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Start Kit,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kerlix Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kit Suture Removal,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $157.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $220.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 "," $1,022.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee Support Brace,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Label IV Day of Week,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $97.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Large Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liquid Skin Protectant,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lotion Hand/Body,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $103.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Male External Cath-Medline,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask, Ear Loop",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask, Full Face Large",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask, Full Face Small",,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask, Nasal Small",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Med Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meplix Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Odor Eliminator Scented,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oral Care Kit,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Pack, Basic",,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Palm Cups 60mm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Palm Grip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Passy Muir Valve,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Petroleum Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pneumothorax Set,,,,," $1,244.44 "," $1,244.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Port Protector,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $118.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 "," $1,866.07 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 "," $2,014.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pressure Port for Therapep,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $101.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Razors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reacher 32,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ready-Bath,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rectal Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $596.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Set Catheter Irrigation,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoe Horn Long 24,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoulder Immobilizer,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shower Caps,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skin Closure Strips,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $42.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Soap Deodorant,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Speicmen Collection Commode,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spenco Boot--Outer,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Saline 100ml,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Sheets,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Water 1000ml,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suction Canister 1200cc,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suction Canister 2400ml,,,,, $34.98 , $34.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 "," $1,417.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suture Removal Kit,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 20cc Ll,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Syringe, Insulin",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tape Durapore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tape Measure,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tape Micropore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tape Transpore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tape Transpore 2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $186.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theraband Green,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Therapep,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theraputty Red,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theraputty Yellow,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thick & Easy,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thigh Garment Scd,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tongue Blade,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trac Y Connector,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $44.37 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Tray, Percutaneous",,,,, $629.64 , $629.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tubing Corrugated,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $18.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinal Female Guardian,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinal Male Supreme,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vac Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vent Circuit,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vest Starter Kit,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Viscopaste Pb7,,,,, $109.18 , $109.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitalstim Therapy,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Water Pitcher 22oz,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wedgesx2,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Weighted Bendable Fork,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wing Infusion 22inch,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Winged Infusion 20in,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $239.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adult Wipes,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alcohol Preps,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alldress Dressing,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Catheter,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arm Sling,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Baby Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandaid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Briefs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Comb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Connecting Tube,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Denture Adhesive,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Denture Cup,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Deodorant,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dressing Change Charge,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duoderm Dressing,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,E Cylinders,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enema Bag With Soap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ensure,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Extension Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feeding Set,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fleets Enema,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucerna,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Strip,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Graduated Container,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gt Bag,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hair and Body Shampoo,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heel Protectors,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hibiclens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Hose, Care Knee",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Introcan 22g 1 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kerlix,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kleenex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lancet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lice Treatment,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lip Balm,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Messengile Douche,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mouthwash,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nail File,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasal Cannula,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebulizer,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,No Rinse Shampoo,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,O2 Concentrator,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perineal Cleaner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Posie Pads,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Q-Tips,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shave Cream,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skin Prep Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Slipper Socks,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Soap Bar,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Speci-Hat,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Specimen Container (Sterile),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Staple Remover Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe With Needle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Telfa Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thick It,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toothbrush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toothette,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toothpaste,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tubing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Underpads,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinal,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vaseline,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vial Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vista Pump,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vista Pump Set,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wash Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Water Pitcher,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wound Cleaner,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wound Gel,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Emery Board,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Emesis Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,2 3/4  Wafer,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"4"" Kerlick",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"4""drainable Pouch",,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ace Bandage,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adult Pullups Large,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adult Pullups Medium,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adult Pullups Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bed Pan,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ben Gay,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Briefs Extra Large,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Briefs Large,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Briefs Medium,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Briefs Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Butterfly Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Autoguard 20,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Catheter, Condom",,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Catheter, Foley",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clean Catch Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colostomy Pouch,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Denture Brush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ensure Shake,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enteral Feeding Kit,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $822.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heel Suspension Boot,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Horizon Tubing,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hoyer Lift Pad,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydrogel Dressing,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ileostomy Bag,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Incentive Spirometer,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulated Water Carafe,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iodine Prep,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Pump Daily,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lubricating Jelly,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lubriderm,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medseptic Packet Each,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebulizer W/Mask,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nizoral Shampoo,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Non Adherent Pads,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ocean Spray,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Paper Tape,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Personal Belonging Bag,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Resource 8 Oz Can,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sarna Lotion,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Selson Blue Shampoo,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Speciman Cups,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Straight Catheter,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suplena 120 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 12cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 1cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 3cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 5cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ted Hose Knee High,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ted Hose Thigh High,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tinactin Powder,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Unna Boot 4""",,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vaseline Pkts,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wafer,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bariatric Bed,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Air Mattress,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trapeze Bar,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wound Vac,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bariatric Lift,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CATHETER MIDLINE,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Catheter, short term, straight",,,,," $2,543.00 "," $2,543.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blanket Bair Hugger,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,STERILE CAP MALE,,,,, $0.50 , $0.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 "," $2,713.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,B.D. Neelde,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Distilled Water,,,,, $11.19 , $11.19 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Steri Strips,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sling Arm Large,,,,, $28.18 , $28.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Collar Cervical,,,,, $84.62 , $84.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoe Post OP,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Boot Ankle Contracute,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Belt Gait 60inch,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Decannulation Plug,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $41.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abduction Wedge,,,,, $551.60 , $551.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Airway Guedel 70mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Airway Guedel 80mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $8.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Surgitube Large,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Surgitube Small,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $282.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee Immobilizer,,,,, $271.24 , $271.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $79.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $26.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $40.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $259.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $259.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $27.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $16.35 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Admission Set Up,,,,, $831.04 , $831.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cannula High Flow,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coloplast Clamps,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Control Mitt,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Isosource,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Jevity,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Juven,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Nepro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Oxepa,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Prostat,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $219.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trapeze Free Standing,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Central Line Dressing Kit,,,,, $822.48 , $822.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eclipse Injection Needle,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humid Vent 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aldosterone Bld,,,,, $938.10 , $938.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amitriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Huab,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Yob,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Benzodiazepines,,,,, $302.10 , $302.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamezipine Free,,,,, $237.44 , $237.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath for Collection,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPT Initial,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPT Subsequent,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiv-1,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lead Urine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Manual Differential,,,,, $623.28 , $623.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Microalbumin Urine,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myoglobin,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Parvo Virus Igg,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Parvo Virus Igm,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 "," $1,968.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $68.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protime,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $215.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Smear Nasal Eos,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sputum Collection,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinalysis Dipstick,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venipuncture,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,West Nile Virus Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,340 Measure Volume,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Afb Culture,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Afb Sensitivity,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ANA Titer & Pattern,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Scl 70,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antigen Type,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aso Titer,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bld Type Du,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Marrow Studies,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CBC With Auto Diff,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cell Count Csf,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlamydia by Probe,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlamydia Group Ab,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $549.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cmv Igm Ql,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crystal ID Synovial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Directogen Serum,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eosinphhil Count,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epstein Barr Ea,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epstein Barr Ebna,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epstein Barr Vca,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Era,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Febrile Agglut Each,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fecal Fat,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fibren Split Product,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fibrinogen Quan,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flow Cytometry Dna,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,H Pylori,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Handling Fee,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemo Influenza,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $348.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiv,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiv Viral Load,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiv Western Blot,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Holter Monitor 24hr,,,,, $414.00 , $414.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hpv Culture,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iep Except Serum,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iep Serum,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kell Ag Titer,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lupus Anticoagulant,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Manuel Diff,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metanephrines Urine,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Misc Immun Proc,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ob Screen,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Occult Blood,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ova Paras Smears,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pertussis Smears,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Cnt,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Count Auto,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pra,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein Electrophore,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rapid Group A Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rapid Group B Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Retic Absolute,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $397.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rocky Mountain Igg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,RPR,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,RPR Titer,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,RSV,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,SED Rate,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Semen Analysis Compl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Semen Post Vasectomy,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sickle Cell Prep,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Smear Review by Path,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urea Breath Collect,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinalysis,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinalysis Chem Only,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urine Immun Fixation,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urine Microscopic,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Varicella,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,WBC,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,West Nile Igm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wet Mount,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $546.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $701.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $719.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ova Parasites Ocp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $839.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urine 24 Hour,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urine Culture,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,WBC W Differential,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT/INR,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TPA tissue plasminogen,,,,, $136.12 , $136.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Acetone, Quant",,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Actaminophen,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acth,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acth Treatment,,,,, $467.46 , $467.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albumin Body Fluid,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alcohol Blood,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alcohol Urine,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aldolase,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $443.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alkaline Phosphatas,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amikacin,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amiodorone,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ammonia Blood,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amphetamine,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amylase Body Fluid,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amylase Isoenzyme,,,,, $723.98 , $723.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amylase Serum,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Androstenedione,,,,, $929.62 , $929.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antidiuretic Hormone,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antihistone Ab Quant,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apolipoprotein A,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apolipoprotein B,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arsenic Any Source,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,B Naturetic Peptide,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Barbiturates Quant,,,,, $445.20 , $445.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Basic Metabolic Panel,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bilirubin Direct,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bilirubin Total,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bupropion,,,,, $587.24 , $587.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,C Peptide,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Blood,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Ionized,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcium Urine 24,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carbon Diox Co2,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carboxyhemoglobin,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Carotene,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Catecholamines Total Urin,,,,, $710.20 , $710.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CEA,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ceruloplasmin,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chloride 24hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chloride Blood,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chloride Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholesterol Hdl,,,,, $201.40 , $201.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholesterol Total,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholinesterase Rbc,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 "," $1,577.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chromatography Quant,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Comp Metabolic Panel,,,,, $684.76 , $684.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Copper,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cortisol Am,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cortisol Pm,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cortisol Serum,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPK Isoenzymes,,,,, $412.34 , $412.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPK-Mb,,,,, $354.04 , $354.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $214.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Creatinine Clearance,,,,, $286.20 , $286.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Creatinine Serum,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Creatinine Urine Random,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cryoglobulin,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyanide,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyclosporine Level,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cystine Urine 24hr,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diazepam Assay,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Digoxin Lab,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dimeric Inhibin A,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doxepin (Sinequan),,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drug Screen Urine,,,,, $619.04 , $619.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Drug Screen:confirmation,,,,, $196.10 , $196.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D-Xylose,,,,, $526.82 , $526.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electroholresis-Serum,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electrolyte Panel,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Enzymatic Digestion,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Erythropoietin,,,,, $848.00 , $848.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estradiol Serum,,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estriol Unconjugate,,,,, $263.94 , $263.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estrogen Total,,,,, $694.30 , $694.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estrone,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fecal Fat Quant,,,,, $539.54 , $539.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fecal Fat Screen,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ferritin,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Folic Acid Rbc,,,,, $337.08 , $337.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Folic Acid, Serum",,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $607.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $474.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastrin Serum,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,General Health Panel,,,,," $1,186.14 "," $1,186.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gentamicin Level,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ggt,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucometer Lab,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose G6pd,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Random,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $64.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucsoe Blood,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Haptoglobin Quant,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemoglobin Electroph,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemoglobin Plasma,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemoglobin Urine,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemosiderin,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatic Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitus Panel,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Homocystine Serum,,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxyproline Free,,,,, $986.86 , $986.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immunoglobulin E,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $744.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immunolgobulin Igo,,,,, $677.34 , $677.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Impramine,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Total,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intrinsic Factor,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iron,,,,, $170.66 , $170.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iron Binding Capacity,,,,, $54.06 , $54.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketone Serum,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,L/S Ratio Quant,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactoferrin by Eia,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LDH Body Fluids,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LDH Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LDH Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lead Blood,,,,, $304.22 , $304.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lidocaine,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipase,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lipid Profile,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lithium Quan,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loh Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Loh Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Luteinizing Hormone,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Magnesium,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mercury,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $692.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methadone,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $728.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Microalbumin,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $603.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myoglobin Urine,,,,, $497.14 , $497.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Niacin Level,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nicotine,,,,, $243.80 , $243.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Noratriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nucleotidase 5,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Occult Blood Gastric,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Occult Blood Stool,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oligoclonal Bands,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Opiates Quantitative,,,,, $278.78 , $278.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Osmolality Blood,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Osmolality Urine,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Parathyroid Hormone,,,,, $422.94 , $422.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $409.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pcr Amplification,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ph Body Fluid,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenobarbital,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin Free,,,,, $536.36 , $536.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phosphatase Acid Total,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phosphatydylglycerol,,,,, $696.42 , $696.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Porphob Urine (Quant),,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Random Urine,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Serum,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pre Albumin,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Primidone (Mysoline),,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Procainamide,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Proclactin,,,,, $509.86 , $509.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Progesterone,,,,, $410.22 , $410.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein 24hr Urine,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein Phoresis Serum,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein Phoresis Urine,,,,, $345.56 , $345.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein Random Urine,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein S Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein Total,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PSA Total,,,,, $399.62 , $399.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pseudocholinesterase,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Quinidine Level,,,,, $358.28 , $358.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reducing Substance Stool,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renal Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Salicylate,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 "," $1,499.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sgot or AST,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sgpt or ALT,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Body Fluid,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Serum,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sodium Urine,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Specific Gravity -Other,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stone Analysis,,,,, $349.80 , $349.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stone Analysis Quan,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stone Rosk Citrate,,,,, $490.78 , $490.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stool for Reducing Substances,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,T-3 Free,,,,, $966.72 , $966.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,T-3 Resin Uptake,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,T-3 Total,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tacrolimus,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Testosterone Free,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Testosterone Total,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Theophylline Level,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thiamine Vit B1,,,,, $614.80 , $614.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroxine Free T4,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroxine Total T4,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tibc Without Iron,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tobramycin Test,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transferrin,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trazodone,,,,, $579.82 , $579.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tricyclic,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Triglycerides,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Troponin Quantitative,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Trypsinogen Serum,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tryptase Serum,,,,, $651.90 , $651.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tularemia Agglutinins,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uric Acid Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uric Acid Serum,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vancomycin Test,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vasopressin,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin A-Test,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B12,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $925.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin C Blood,,,,, $625.40 , $625.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 "," $1,055.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 "," $1,023.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin D Level,,,,," $1,085.44 "," $1,085.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vitamin E Serum,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vma Urine 24hr,,,,, $487.60 , $487.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Volatiles,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zinc Serum,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renin,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Acetylcholine Recep,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Albumin Serum,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amniostat,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti-Histone Abs,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Barbiturates Confir,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chloride Urine,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholinesterase,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Creatinine Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dhea S Serum,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Estrogen Level,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eth0suximide,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ethylene Glycol,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gloucose Body Fluid,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose 5 Hr,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glucose Whole Blood,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiaa Urine,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Iron Serum,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,L/S Ratio,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lactic Acid,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,LDH,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ldl Measured,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liver Profile,,,,, $521.00 , $521.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Methylmalonic Acid,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Misc Chem/Tox,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Osullivan,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Phosphorus Serum,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Potassium Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PSA Free,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Topiramate Quant,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Uric Acid Urine,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vma Urine,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Keppra Serum,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ketosteriods,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liver Function Test Lft,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ab Encephalitis California,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Adenovirus Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $175.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $498.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Aspergillus,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Blastomycosis,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Brucella,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Coccidioides,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Dna,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Elution,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $592.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Leptospira,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Rpn,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Sjogren,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antiphospholipid,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aso Screen,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bartonella Antibody,,,,, $662.50 , $662.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bences Jones Protein,,,,, $449.44 , $449.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blood Typing Rh (0),,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blood Typing Rh (D),,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bordetella Pertussis,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brucella Obortus,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,C Reactive Protein,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,C1 Esterase,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ca 125,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ca 15-3,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ca 19-9,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ca 27-29,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Calcitonin,,,,, $390.08 , $390.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cardiolipin Antibody,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Celiac Disease Antibod,,,,," $1,424.64 "," $1,424.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cell Total Count,,,,, $636.00 , $636.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlamydia Antibody,,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cie,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clotest/Culture Urine,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Complement Antigen,,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Complement C1 Function,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Complement C3 Antigen,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Complement C4 Antigen,,,,, $89.04 , $89.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Complement Total (Ch 50),,,,, $597.84 , $597.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crp Ultrasensitive,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cryptococcal Antigen,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytomegald Igg,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Direct Coombs,,,,, $137.80 , $137.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dna Antibody Single,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Du Typing Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ehrlichia Titer,,,,, $217.30 , $217.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Encephalitis East Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Encephalitis ST Louis,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epstein Barr (Ea),,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feb Agglut Ea,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feb Agglut Papa A,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feb Agglut Typh D,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Feb Agglut Typh H,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Frozen Blood Preparation,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fta-Abs,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $342.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $356.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis C Antibody,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis C Riba,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Herpes Simplex Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Herpes Simplex Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heterophile Abititer,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hla Typing B27,,,,, $649.78 , $649.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immundelectrophoresis,,,,, $363.58 , $363.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $546.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Islet Cell Antibody,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Legionella Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $310.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lyme Disease Antibody,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mhatp,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mitochondrial Antibody,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mono Test,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mumps Antibody,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Antibody,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pneumococcal Abs,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pooz Echinococcus,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Processing Autologous,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ra Titer,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rh Phenotyping,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $508.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rotavirus,,,,, $569.22 , $569.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rubella Igg,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rubella Specific Igm,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rubella Titer,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scheroderma Antibody,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $463.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 "," $1,043.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroglobulin Antib,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toxoplasma Igm,,,,, $405.98 , $405.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Varicella Igg,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Varicella Igm,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rubeola Titer,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vorl-Csf,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody ID,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Screen,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crossmatch is,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antithrombin Iii As,,,,, $771.68 , $771.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apc Resistance,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aptt,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Automated Platelet Count,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bleeding Time,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CBC Complete Automated,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coagulation Time Activ,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D Dimer,,,,, $517.28 , $517.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,D-Dimer Quantitative,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eosinophil Count,,,,, $181.26 , $181.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor 8 Level,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 "," $1,073.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor Ix Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor V Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor X Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor Xi Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor Xii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Factor Xiii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fibrinogen Activity,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hematocrit,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hematocrit Spun,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemoglobin,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $332.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kleihauer-Betke,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Morphology,,,,, $520.46 , $520.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Aggregation,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Countaiuid,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Countimanual,,,,, $146.28 , $146.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Function Assay #1,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Platelet Neutralization,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein C Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Protein S Total,,,,, $855.42 , $855.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PTT Practionated,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rbc Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reticulocyte Count,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $435.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sedrate-Westergren,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,WBC Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wnc Diff Only,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Af N Men A/Y,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Afb ID Direct Probe,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aft Smear Only,,,,, $193.98 , $193.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ag N Men C/U,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clostridium Diff Tox,,,,, $712.32 , $712.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Anaerobic,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Blood,,,,, $84.80 , $84.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Body Fluid,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Cath Tip,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Chlamydia,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Csf,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Fungus (Blood),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Fungus (Skin),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Gc Definitive,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Genital,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $311.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Herpes Typing,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Non Urine ID,,,,, $81.62 , $81.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Sputum,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Stool Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Throat,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Throat or Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Urine,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Urine ID,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Viral,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Culture Wound Aerobic,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fungus Smear,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gram Stain,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $251.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $575.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis C Quant,,,,, $250.16 , $250.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $922.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Herpes Virus Isol,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Histoplasma Antigen,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $395.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $702.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,India Ink Prep,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Influenza B by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Jc Virus by Pcr,,,,," $1,089.68 "," $1,089.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Koh Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Legionella Antigen Urine,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Malaria Smear,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $884.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neutrophil Ab,,,,, $267.12 , $267.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ova and Parasites,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pinworm Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Refacid Fast Culture,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,RSV Rapid Test,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sensitivity Mic,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Strep Group A Antigen,,,,, $206.70 , $206.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,West Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cult Fungi Other,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cult Grp B Strep,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bile Urine,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bile Urine Auto,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reducing Substance Urine,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Timed Volume Measurement,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinalysis Macro Only,,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urinalysis Micro Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Indirect Coombs,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 "," $2,905.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $230.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clinical Consult Limited,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $149.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flow Cytometry,,,,, $577.70 , $577.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fna Evaluation,,,,, $204.58 , $204.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $532.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cytology Cell Block,,,,, $281.96 , $281.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Decalcification Procedure,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $638.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pathology Consult In Surg,,,,, $815.14 , $815.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pathology Level I,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pathology Level Ii,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pathology Level Iii,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pathology Level IV,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pathology Level V,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pathology Level Vi,,,,, $617.98 , $617.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Special Stain Group Ii,,,,, $120.84 , $120.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Special Stains Group I,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Special Stains Group Ii,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abdomen 2 Views,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abdomen 3 Views,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abdomen IV (Kub),,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abdomen IV Port,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abdomen One View,,,,, $360.00 , $360.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $869.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ac Joints Bi,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ankle Complete,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Athrect Periph Artery,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Barium Enema,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Barium Enema Red Svc,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Barium Swallow,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biliary Stone Extraction,,,,, $673.00 , $673.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Age Studies,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Density Dexa,,,,, $633.00 , $633.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Survey Limited,,,,," $1,132.00 "," $1,132.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Breast Needle Local,,,,," $1,336.00 "," $1,336.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Breast Surgical Specimen,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronchography Bi X&i,,,,," $1,106.00 "," $1,106.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $991.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 "," $1,281.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 "," $1,265.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 "," $2,238.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $852.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $670.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Clavicle Complete,,,,, $373.00 , $373.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $753.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diskographylumbar S&i,,,,," $1,339.84 "," $1,339.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abdomen Complete,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ankle 2 Views,,,,, $347.00 , $347.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elbow 2v Comp,,,,, $309.52 , $309.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elbow Min 3v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Embolization Therapy,,,,," $8,848.00 "," $8,848.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Embolization Therapy S&i,,,,," $5,008.00 "," $5,008.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hip Min 2v,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foot Min 3 Views,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Forearm 2 Views,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand 2 Views,,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hip Operative Proc,,,,, $939.16 , $939.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Min 3 Views,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $334.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hip Unilat 1 View,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $576.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ercp Biliry Duct,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Esoph With Video,,,,, $890.40 , $890.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Esophagus,,,,, $557.56 , $557.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eye for Fb,,,,, $387.96 , $387.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Facial Bone 3 Views,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Femur Min 2views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Film Copy X-Ray,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $446.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 "," $1,691.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flouro More 1 Hour,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoro Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fluoro W/O Film,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foot 2 Views,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humerus Min 2v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 "," $1,105.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $475.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ivp Retrograde,,,,," $1,017.60 "," $1,017.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $948.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 "," $1,013.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ivus Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee 3 Views,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee Min 4v,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mandible 1-3v,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mandible Min 4v,,,,, $545.90 , $545.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $492.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 "," $2,428.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 "," $2,308.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 "," $2,134.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Neck Soft Tissue,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nephrostogram,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 "," $1,580.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Optic Foramina Exam,,,,, $690.06 , $690.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orbits 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orbits 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Panorex,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pelvimetry,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 "," $1,297.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 "," $3,047.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $709.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renal Angio Bilat,,,,," $3,838.26 "," $3,838.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renal Catheter Placement,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $715.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scapula (2 Views),,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scapula Complete,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sella Turcica,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoulder 1 View,,,,, $374.18 , $374.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sialography S&i,,,,, $601.02 , $601.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinuses <3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinuses 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinuses Waters View,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skull 1-3 Views,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skull Min 4v,,,,, $648.72 , $648.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Small Bowel Series,,,,," $1,602.72 "," $1,602.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $849.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $640.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Thoracic 2v,,,,, $570.28 , $570.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sternum 1v,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sternum 2 Views,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Subtraction Study,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Svc,,,,," $1,161.76 "," $1,161.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tmj Bi,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tmj Unilat,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Toes 2 Views,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 "," $1,619.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 "," $2,174.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $910.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 "," $2,999.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Upper Gi,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Upper Gi W/Air,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Upper Gi W/Kub,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ureter Stent Placement,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 "," $1,048.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 "," $1,495.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 "," $1,827.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venography Caval Inferio,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wrist 2 Views,,,,, $288.32 , $288.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xray Reading Outside,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zygomatic Arch,,,,, $393.26 , $393.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,A/C Joints Bilateral,,,,, $205.00 , $205.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ankle Ap & Lat,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Coccyx,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colon Barium,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Colon Barium W/Air,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cystogram S&i,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elbow Ap & Lat,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elbow Complete,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Elbow Complete I/F,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foot Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foot Complete I/F,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Forearm 1 Joint,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Complete I/F,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hand Two Views,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hip 2 Views I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hip Uni Two Views,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Facial Bones Comp,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Femur,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fingers,,,,, $198.00 , $198.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foot Ap & Lat,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Humerus,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee 2 Views I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee Ap and Lateral,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Knee Completed,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kub,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mandible Complete,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mandible Copl I/F,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mandible Limited,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mastoid Complete,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nasal Bones Only,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Os Calcis,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pelvis 2 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pyelogram Retro,,,,," $1,762.00 "," $1,762.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ribs Bilateral,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ribs Unilateral,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sacroiliac,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sacrum,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scapula,,,,, $216.00 , $216.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoulder 3 Views,,,,, $335.00 , $335.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoulder Compl I/F,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Shoulder Limited,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinuses Complete,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sinuses Limited,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skull Complete,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skull Complete I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skull Limited,,,,, $261.00 , $261.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $330.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Cervical Compl,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Lumb Complete,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sternaclavc Jnts,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sternum,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tempmndublr Jnts,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tibia and Fibula,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Upper Gi Series,,,,, $609.00 , $609.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venogram Unilateral,,,,," $3,111.00 "," $3,111.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wrist Ap & Lat,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wrist Complete,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bladder Scan,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Contrast Xray Uniary,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Foot Complete 3 Views,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orbit X-Ray,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 "," $3,972.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 "," $3,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Aortic Arch,,,,," $2,463.44 "," $2,463.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 "," $1,564.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 "," $1,187.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 "," $3,897.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 "," $1,618.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 "," $3,420.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 "," $2,921.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Carotid CPT,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 "," $2,033.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 "," $3,864.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 "," $3,117.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 "," $3,878.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 "," $3,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Renal Unilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Retro Brachial,,,,," $1,313.34 "," $1,313.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 "," $2,079.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 "," $1,248.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Visceral S&i,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 "," $3,919.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angiography Spinal S&i,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 "," $2,784.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 "," $2,119.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplasty Periph Art,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 "," $2,226.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arthrography Hip S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arthrography Knee S&i,,,,," $1,246.00 "," $1,246.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 "," $1,253.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Artho Shoulder,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 "," $2,454.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aorta Abdominal,,,,," $4,554.00 "," $4,554.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 "," $3,069.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 "," $3,842.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aortoram Abdominal,,,,," $1,210.52 "," $1,210.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest 1 View I/F,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Complate 4 Views,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Inspir/Exp,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Lat Decub,,,,, $438.00 , $438.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Pa 2 Views,,,,, $556.00 , $556.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Pa Single View,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Port,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest One View,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Three Views,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chest Two Views,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 "," $7,310.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $924.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Imaging Spect,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 "," $2,138.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 "," $1,503.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $889.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cisternography,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liver Funct Study,,,,," $2,514.32 "," $2,514.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Liver Scan (Spect),,,,," $2,047.92 "," $2,047.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lung Perfusion,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Lung Ventilation Scan,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 "," $1,576.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 "," $5,828.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 "," $3,110.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Parathyroid Scan,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Scan White Blood Cell,,,,," $3,372.92 "," $3,372.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 "," $2,176.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Schilling Test W/Factor,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 "," $1,020.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Testicular Imaging,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 "," $2,054.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 "," $2,684.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 "," $1,241.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tumor Local Spect,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tumor Local Whole Body,,,,," $2,575.80 "," $2,575.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastric Emptying Scan,,,,," $5,148.42 "," $5,148.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 "," $5,990.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 "," $2,805.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastrographin Liquid,,,,, $434.60 , $434.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Chest W/Con,,,,," $4,525.14 "," $4,525.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 "," $4,650.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 "," $1,108.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 "," $4,091.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Pelvis W/Con,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Facial W/O,,,,," $1,693.00 "," $1,693.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 "," $2,254.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 "," $7,418.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 "," $1,682.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Head W/Contrast,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Head W/O Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 "," $1,966.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Iac W/O Cont,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 "," $2,941.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Neck W/Contrast,,,,," $2,894.86 "," $2,894.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 "," $3,922.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $673.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Crystal Analysis,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Abd W/Con,,,,," $2,140.14 "," $2,140.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Abd W/O Con,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 "," $3,997.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Guided Needle Loc,,,,," $2,268.40 "," $2,268.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 "," $7,174.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $842.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 "," $1,992.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 "," $3,739.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 "," $3,963.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 "," $4,854.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 "," $2,595.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 "," $3,561.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 "," $3,587.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Needle Bx,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $384.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Extremity CPT,,,,, $961.42 , $961.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Peripheral CPT,,,,," $5,450.52 "," $5,450.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Renal,,,,," $3,396.24 "," $3,396.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angio Visceral CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 "," $4,096.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 "," $5,325.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplasty Iliac,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aorta Catheterization,,,,, $934.92 , $934.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aortogram Abd CPT,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Appl Unna Boot,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 "," $5,719.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 "," $3,491.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 "," $1,179.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherect Aorta Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 "," $3,442.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 "," $2,444.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 "," $2,200.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Lung,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $785.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $951.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 "," $1,744.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronchography Uni S&i,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 "," $2,339.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bx of Kidney CPT,,,,, $952.94 , $952.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 "," $3,093.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 "," $7,648.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 "," $7,369.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 "," $1,509.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $913.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 "," $3,933.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Central Venous Cath,,,,, $289.38 , $289.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $634.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 "," $2,374.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 "," $1,955.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Embol Extracranial CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Embolization CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $392.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ercp Radiology CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 "," $3,265.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $698.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,I&d Cyst Complex,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,I&d Cyst Simple,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 "," $1,930.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ins Chest Tube,,,,, $642.36 , $642.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insert Central Line Percu,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 "," $3,279.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 "," $4,208.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 "," $2,903.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 "," $5,344.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 "," $3,210.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $786.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $659.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $531.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 "," $3,668.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 "," $2,935.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 "," $2,024.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 "," $1,605.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 "," $2,245.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 "," $7,211.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 "," $3,402.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 "," $1,904.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $864.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 "," $3,612.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $899.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 "," $3,793.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Replc Picc Only Surg,,,,," $2,452.84 "," $2,452.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reposition Leads,,,,," $3,916.70 "," $3,916.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skin Biograft,,,,," $1,718.26 "," $1,718.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Skin Biograft Add-On,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Split Skin Graft,,,,," $3,782.08 "," $3,782.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Stent Placement,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 "," $1,386.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thoracentesis,,,,, $804.54 , $804.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 "," $2,257.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 "," $2,378.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 "," $2,167.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tissue Graft Other,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tracheostomy Planned,,,,," $3,892.32 "," $3,892.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 "," $1,170.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 "," $1,092.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 "," $3,390.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,General Anesthesia,,,,," $2,207.98 "," $2,207.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 "," $1,138.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $98.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Blood Admin,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Transfuse Blood Products,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Echo Routine,,,,, $768.50 , $768.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ultrasound Extremity,,,,," $1,598.48 "," $1,598.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Renal Sonogram,,,,," $1,749.00 "," $1,749.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 "," $2,414.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mammogram Special,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Echo Color Doppler,,,,, $703.84 , $703.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Echograhy Transrectal,,,,, $858.60 , $858.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 "," $1,080.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 "," $2,186.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Abdomen Complete,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Abdomen Limited,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Aorta,,,,," $1,011.24 "," $1,011.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Breast Bilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Breast Uni,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Gallbladder,,,,, $675.22 , $675.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 "," $6,321.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Kidney,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Pelvic Complete,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Pelvic Limited,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Retro Limited,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Scrotum,,,,, $747.30 , $747.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Thyroid,,,,, $711.26 , $711.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Transvaginal,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Us Chest,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Us Guide Vascular Access,,,,," $1,134.20 "," $1,134.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Us Kidney,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 "," $1,867.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Abg,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accapella Setup,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Accapella Treatment,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Arterial Puncture,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 "," $1,183.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronch Ther-Initial,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronch Ther-Subs,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronch With Biopsy,,,,," $1,828.00 "," $1,828.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bronch With Brushing,,,,," $1,620.00 "," $1,620.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $798.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Cpr-Code Blue,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Diag Bronch,,,,," $1,286.00 "," $1,286.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Intubation,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mdi Setup,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mdi Treatment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxygen Per Day,,,,, $359.00 , $359.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxygen Setup,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Patient Education,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peak Flow,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pft Pre & Post,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pft Simple,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulse Ox Setup,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rt Assessment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sputum Induction,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suction,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suction Set Up,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Updraft Set Up,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Updraft Treatments,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Vent Check-Daily,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPAP,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,CPAP Mask,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mdi,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Non Rebreather,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxygen Mask,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Suction Equip Daily,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Portable O2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulse Oximeter,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Prosthetic Training 15min,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Massage,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Re-Eval,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Therapeutic Proc,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT-E-Stim,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT-Wheelchair Main,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sensory Integration 15min,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Gait Training 15 Min,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Kinetic Excercises,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Evaluation,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Therap Group 15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Physical Ther. Activities,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Physical Therapy Procedures,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Evaluation/-Go,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Adl 15-Min,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $407.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $282.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Re-Eval - Go,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Tens Application - Go,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Speech Therapy,,,,, $308.46 , $308.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $618.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Speech Therapy Eval,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Swallow Clinical Eval,,,,, $854.00 , $854.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 "," $1,242.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 "," $1,745.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $754.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Echo 2d&m Complete,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Echo D&m Limited,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $489.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Echo Cardiogram,,,,," $4,562.00 "," $4,562.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Ambulance One Way,,,,," $1,214.76 "," $1,214.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Abd W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 "," $7,515.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 "," $6,315.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 "," $4,867.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 "," $6,631.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Brain W/Cont,,,,," $5,235.34 "," $5,235.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 "," $14,057.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Add'l Levels,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,MRI Head,,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mra Head Wo Cont,,,,," $1,312.28 "," $1,312.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 "," $1,906.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,General Recovery,,,,," $1,500.00 "," $1,500.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EKG,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EKG Rhythm Strip,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Electrocardiogram,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 "," $1,215.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 "," $1,196.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EEG Sleep Only,,,,," $1,587.88 "," $1,587.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 "," $1,988.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Mslt,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polysomnography W CPAP,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polysomnography W/4+param,,,,," $5,587.26 "," $5,587.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 "," $6,984.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EEG,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Hemodialysis,,,,, $549.08 , $549.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Peritoneal Dialysis,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Nursing Assessment,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Patient Education Group Sessio,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Educational 60 Mi,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Training Education 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 "," $4,011.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Tcp02,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,EMG Electromyograph,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Commerical,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Aetna,Medicare Managed Care,DRG,,Private Room,,,,," $1,083.00 ", $-   , $-   ," $1,300.00 ",,,Included in DRG Pro Fees not included
Aetna,Medicare Managed Care,DRG,,Semi-Private Room,,,,," $1,051.00 ", $-   , $-   ," $1,300.00 ",,,Included in DRG Pro Fees not included
Aetna,Medicare Managed Care,DRG,,ICU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,500.00 ",,,Included in DRG Pro Fees not included
Aetna,Medicare Managed Care,DRG,,CCU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,500.00 ",,,Included in DRG Pro Fees not included
Aetna,Medicare Managed Care,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ", $-   , $-   , $-   ,,,Not included in contract
Aetna,Medicare Managed Care,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ", $-   , $-   , $-   ,,,Not included in contract
Aetna,Medicare Managed Care,HCPC's,90832,Individual Psychotherapy 30 Mi,HCPC's,90832,Individual Psychotherapy,, $250.16 , $-   , $-   , $-   ,,,Not included in contract
Aetna,Medicare Managed Care,HCPC's,90834,Individual Psychotherapy 45-5,HCPC's,90834,Individual Psychotherapy,, $501.38 , $-   , $-   , $-   ,,,Not included in contract
Aetna,Medicare Managed Care,HCPC's,90853,Group Psychotherapy,HCPC's,90853,Group Psychotherapy,, $326.00 , $-   , $-   , $-   ,,,Not included in contract
Aetna,Medicare Managed Care,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ", $-   , $-   ," $135,450.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ", $-   , $-   ," $4,820.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ", $-   , $-   ," $9,200.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ", $-   , $-   ," $10,595.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ", $-   , $-   ," $32,154.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ", $-   , $-   ," $10,689.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ", $-   , $-   ," $41,783.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ", $-   , $-   ," $14,359.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ", $-   , $-   ," $12,072.00 ",,,Pro Fees not included
Aetna,Medicare Managed Care,DRG,,Interrupted Stay,,,,, $-   , $-   , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Code Blue,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peg Tube Placement,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perfusion 1 Hour,,,,, $369.94 , $369.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Picc Line Insertion,,,,," $2,855.64 "," $2,855.64 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debride Skin Full,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debride Skin Partial,,,,, $351.92 , $351.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 , $652.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 , $620.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 "," $1,240.20 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulsed Lavage,,,,, $184.44 , $184.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wound Care,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitiamin D 600 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,0.9% 10ml Flush,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,1eppra 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,250ml Bolus Ns,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,A&d Ointment,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 "," $3,051.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 "," $3,244.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abreva Cream 2gm,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accuzyme Oint 30gm,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acebutolol 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen 500,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen 650mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen/Codeine,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetazolamide 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetazolamide 500mg,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acyclovir 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acyclovir 500mg Inj,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acyclovir Oint 5gm,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acyclovir Susp 200mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adenosine  6mg Syri,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aggrenox 25/200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albumin 25gm 100ml,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albumin 25gm Vl,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 0.083% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol Inhaler 8,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 , $745.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allegra D 24hr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allopurinol 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alosetron 1mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alphagan 0.2% Drops,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alteplase Vl 1mg,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amikacin 500mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 , $374.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 "," $1,026.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin 1gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin 2gm Inj,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 "," $1,176.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anucort-Hc 25mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aquacel  With Transparent Film,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aquaphor Oint 3oz,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 "," $2,390.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 , $585.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aspirin 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atenolol 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atropine 0.4mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atropine 1mg Syringe,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Augementin Xr 875mg,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aveeno Bath,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacitracin Oint,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 "," $1,595.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Beer 12oz Can,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benicar 40/12.5mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benzocaine (Oragel),,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Black Widow Antiveni Vl,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 "," $3,169.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bss Irr Soln Sol,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 , $508.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Tab : 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Captopril Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 "," $4,211.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carmex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 "," $2,205.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celestone Mdv : 6mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cetaphil Mois Lot,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 , $314.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Charcoal Liquid  25gm,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cipro 500mg Tablet,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Citrical D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 , $169.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 , $245.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 , $308.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Combigan Liquid 5ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Combivir Tablet,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Copaxone 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coumadin 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coumadin 7.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 "," $7,094.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 "," $1,566.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D10 W,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D50w 50ml Injection,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 , $452.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Danazol Cap : 200mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dapsone 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 "," $1,214.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 "," $1,057.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 "," $1,850.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 "," $1,451.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 "," $5,808.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 , $727.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 "," $1,162.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Destroxe 70% 500ml,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 10% 1000mls,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 20% 500ml,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 5% 100ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose Amp : 0.1,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 , $227.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 "," $1,568.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilacor Xr 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem 180,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dipentum Cap : 250mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 , $215.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 "," $8,438.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 "," $2,109.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 "," $6,604.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 "," $1,651.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 , $954.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 , $446.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 , $178.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 , $357.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ephedrine 50mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epidrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 "," $1,669.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 "," $1,591.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 , $921.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 , $776.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epogen 1000 Units,,,,, $904.00 , $904.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 , $614.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 "," $3,354.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 "," $1,225.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 , $512.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 "," $1,602.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythromycin 500mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 "," $1,201.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estrogens Esterified (Menest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Etodolac Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Etoposide Vl : 10mg,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 "," $1,195.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 "," $1,113.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 , $280.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrex 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flanders Butt Oin,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fleet Prep Kit #3,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 , $130.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 , $426.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 , $148.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 , $394.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 , $653.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 "," $1,015.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folic Acid 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide Xl 10mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucagon 1mg Inj,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucosamine 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Gel,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucovance 5/500,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycerin Adult Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycerin Pediatric Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycerin Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 "," $7,368.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 "," $1,020.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guiatuss Dac Syr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Halothane Liquid 250ml,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heparin Antibody,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 , $391.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 , $584.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 "," $1,681.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Icy Hot Cream Cream :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 "," $3,165.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indomethacin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 "," $3,652.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Glargine (Lantus),,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intralipids 20% 100ml,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 , $492.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 "," $1,797.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isentress 400mg Tablet,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Dinitrate,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 "," $1,273.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketamine 100mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lantus 100 Units/ML,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 "," $1,045.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levemir 100 Units/ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lice Comb Ea,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lindane Shampoo 60ml,,,,, $681.00 , $681.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 , $622.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 "," $2,385.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorcet 10/650,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorcet Plus,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 5,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 , $272.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 "," $1,213.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maalox,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magic Mouthwash,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Citrate 8oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Marinol 2.5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maxzide 50/75,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meclizine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace 400mg/10ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Melatonin 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Melatonin 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mepilex,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 , $838.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Merrem 250mg Ivpb,,,,, $690.00 , $690.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methadone 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methimazole Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metronidazole 500mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 "," $1,192.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 , $234.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miochol E Sol : 0.01,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mivacurium Inj 2mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mvp,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mysoline 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nabumetone 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nacl .9% 250ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nadolol 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naprosyn 500mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 "," $3,134.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 "," $1,073.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 "," $2,090.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 , $510.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norcuron,,,,, $886.00 , $886.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 "," $2,522.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin R 100 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolog,,,,," $2,822.00 "," $2,822.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns 1000ml Bag,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns 100ml Bag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns 250ml Adv Bag,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns 250ml Bag,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns 50ml Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns Irrigation 3000ml,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns Plus 100ml Bag,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns Plus 50ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Cream 15gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 , $449.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 "," $1,599.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 "," $1,524.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peg Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 "," $8,933.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 "," $1,999.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pentasa 250mg Capsule,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Petrolatum White Oin,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pindolol Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 , $435.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polycitra Lc Sol,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Premarin 0.625 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prenatal Vitamin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Preparation H Ointment,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Progesterone Microni (Prometri,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 "," $1,389.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protamine 50mg Amp,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 , $409.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinine 325mg Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 , $751.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 , $732.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Refresh Tears 15ml,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renagel 800mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 "," $1,694.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 , $575.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rifampin 300mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 1mg/1ml,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 , $775.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rocaltrol .25mcg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Salsalate Tab : 750mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Silver Nitrate Stick,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 "," $1,455.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 , $275.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 "," $1,622.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sorbitol 70% 30ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 , $484.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Starlix 120mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Water 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Streptomycin 1gm Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 , $288.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulindac Tab : 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulindac Tab : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Surgilube Oin : 60gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Symmetrel 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Symmetrel Syr 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 0.05mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tekturna 150mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 "," $7,624.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 , $344.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 , $685.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetracycline 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 , $560.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thrombin 5000 Unit,,,,, $937.00 , $937.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid Tab : 1grain,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 , $377.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 , $617.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin 300mg Inh,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin 80mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 , $322.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 , $419.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 "," $5,408.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trace Elements 5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trental 400mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 , $694.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tricor 48mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urogesic Blue Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 "," $1,023.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin 1gm Vl,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin 500mg Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vasopressin Vl : 20units,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vecuronium 10mg Inj,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil 240 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil Tab : 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vfend 200mg Tablet,,,,, $764.00 , $764.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 "," $2,499.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Viread 300mg Tablet,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vistaril 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin A 10mu Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $702.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc 10mg Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc 220mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc Oxide Ont,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $402.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 "," $1,332.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $595.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accucheck,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,A/B Otic Drops,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 15 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 30 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 5 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acarbose 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accolate 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accupril 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acidophillus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aciphex 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Actonel 35 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Actos 15 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Actos 30 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Actos 45mg,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advair,,,,, $408.00 , $408.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advair Discus 250/50,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advair Diskus Inh,,,,, $819.00 , $819.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advanced Eye Relief,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advil 200mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aerobid,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aerochamber,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aggremox Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aggrenox ER Caps,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Akwa Tears,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aldactone 25mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alendronate 35mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alendronate 70 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aleve,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Align,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allegra 180 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allegra 600 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allegra-D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Altace 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Altace 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amaryl 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amaryl 4 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ambien 10mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ambien 5mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ambilify 10 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amblify 15 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlopidine-Benaz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anafranil 25 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Analgestic Creme Rub,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anaspaz Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antacid Susp Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antioxidant Vitamins,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anusol Hc Supp,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arimidex 1 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Asacol 400 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ascensia Elite #50,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Asmanex Twisthaler,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aspercreme 10%,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Asprin 81mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atacand 16 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atacand 32 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atarex 25mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atenolol 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atenolol 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ativan 1mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ativan 2mg/ML,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atrovent Inhalation,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atrovent Inhaler,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avandia 2mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avandia 4mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avapro 150mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avelox 400mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azo Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,B-1,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Baclofen 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bactrim Ds,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $401.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benadryl 25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benadryl 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benicar 20mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benicar 40 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benicar 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztrop 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztropine 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betapace 80 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bethameth Driprop .5,,,,, $499.00 , $499.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bethanechol 50mg,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biaxin 500 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisacodyl 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biscolax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisoprolol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Black Cohosh,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blistex Lip Medex,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Boniva Tab 150,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Boost,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bumex 1mg,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspar 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspar 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspirone 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspirone 15 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspirone 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspirone 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bystolic 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calan 120 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calan Sr 180mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium 600+d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Carbonate 60,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Caltrate 600 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Campral 333 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Capoten 25mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Captopril 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Captoril 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazepine 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazepine 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardina 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardura 2 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cecon Bottle,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftin 250mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celebrex 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celebrex 200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celexa 20 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cellcept 250mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Centrum Silver Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Century 50 Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Century Senior Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cepacol Lozenges,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlestyramine Packet,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chloraseptic Spray,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorex-A Tablets,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorophyll 3mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorpromazine HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholestyramine Packs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Citalopram 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Citalopram 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Citalopram 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clarinex 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Claritin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cleocin 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clobenzaprine HCL,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine .2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrim Antifungal,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clozaril 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cogentin 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cogentin1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Col-Benemid,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Combigan Eye Drops,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Compazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Compound Rx 30gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Comtan 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Copaxone 20mg,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cordarone 200mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Corgard 40mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Corge 12.5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Corona Ointment,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Correc Cr 40mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cosopt Eye Drops,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coumadin 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cozaar 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cozaar 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cozaar 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crestor 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cymbalta 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cymbalta 30mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytra K 5ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darvocet N 100mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darvon 65mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depo Provera,,,,, $729.00 , $729.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desipramine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desyrel 100mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Detrol La 4 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diabeta 5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diclofenac Sod,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diflucan 150 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin 250mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin 50mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem ER 120,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan 160 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphedryl Sod,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divan 40mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Docusate Calcium,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Donnatel/Maalox,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxazosin Mesylate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxycycline 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dss 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dss W/Casan,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dulcolax,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duoneb 2.5,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dyazide,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dynapen 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dytan 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Effexor Xr 150mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Effient 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elavil 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $235.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elnorm 6mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril Maleate,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 "," $1,408.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Esidrix 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eskalith Cr,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estazolam 1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estropipate 0.625,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Etodolac 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,E-Vista 60 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Evoxac 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exelon 3mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exelon 6 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exforge 5 320mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eye Stream 30ml,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Famotidine 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Felodipine ER 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Femera 25mg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feosol,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fergon,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fexofenadine HCL,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fiber Laxative 625,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fiber Powder,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fibercon 500mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fibercon 625 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Finasteride 5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fioricet 1 Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flagyl 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flonase Nasal Spray,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $230.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flu Vaccine,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fludrocortisone Ace,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoprazine 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flurazepam,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluticasone 50mcg,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluzone,,,,, $237.00 , $237.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folamin Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foltx Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fortical Nasal Spray,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fosamax 70 Mg,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fosinopril/Hctz,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabitril 12mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Genasyme 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Genebs 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Genteal Drops,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 20 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $654.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 80 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geritol Complete,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucophage 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucotrol 5mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucovance 2.5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycolax 255 Gram,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glynase 3mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guanfucine 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 5 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 5mg/ML,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol ML 120,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hcts 1% 30gm,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humalog Ins Inj,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humulin 70/30,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrea 500 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hypotears Eye Drops,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hytrin,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,I Caps Plus,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Imdur 30 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immitrex 50 Mg,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immodium 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inderal 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inderal 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inderal La 120 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inspra 25 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Humulin R,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Invega 3 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isopto Tears,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isordil 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Nacl,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Januvia 50 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Jevity 1.5,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Juven,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K Dur 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keflex 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keflex 500mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kenalog,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $461.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keppra 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Klonopin 1 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Konsyl Powder,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Labetalol HCL,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactaid Fast Act,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamictal 100mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamictal 150mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamictal 25mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lantus Insulin 100,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lantus Insulin Inj,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Latuda 40 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Laxative Suppository,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lecithin 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lescol 20 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lescol Xl 80mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levaquin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levaquin 500mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levemir Vl,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothroid .05 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothroid 0.125,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothroid 75mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroid 25mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levthyroxine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lexapro 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lexapro 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Limbrel 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lioresal 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipitor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipitor 20 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipitor 40mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lodine 500 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lofibra,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lomox Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loniten 2.5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loperamide Hci Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lopid 600 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lopressor 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loratadine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab-5,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotensin 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovastatin 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovaza 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovenox 40mg,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loxitane 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lumigan Eye Drops,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lunesta 1 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lunesta 2 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lunesta 3 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lyrica 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lyrica 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lyrica 300 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maalox 0,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Macrobid 100mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mag Ox 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Citrate,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Oxide 241,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mavik 1 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maxzide 75/50,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medrol Dose Pak,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Susp. 5ml,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mephyton 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metaformin 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metamucil Pkt,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin 1000 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin 850 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin HCL 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methadone HCL 10mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methotrexate 25mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoclopramide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoclopramide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metolazone 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Succ,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mevacor 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miacalin 200u Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mi-Acid Gas,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Micardis 40 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Migrazone Capsules,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Minocin 100mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miralax Packet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miralex 255 Gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Moban 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Moban 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Monopril 20mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Motrin 120ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Motrin 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Motrin Susp 5ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucinex 600 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multigen Plus Caplet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multivitamin With Mineral,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Murine Tears Plus,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mylicon 80,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nadolol 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Namenda 10mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Namenda 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naphcon-A 5ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen 250 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen 500 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen Sod,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasacort Aq,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasal Solutions,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $557.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nature Tear Drops,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Navane 5 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nb Valerian Root,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neosporin Ung Pk,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neurontin 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neurontin 300 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nexium 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nexium 40 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Niacin 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nifedipine 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Niferex 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nilandon 150 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroquick,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norco 10/325 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norpramin 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norvasac 5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norvasc 10mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin 70/30,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin R 100 Units,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolog Mix 70/30,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Occuvite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Omacor 1 Gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Omnicef 300mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,One A Day,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,One-A-Day Mens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Opana ER 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orajel,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orap 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Os Cal 500d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Osteo Bi Flex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxytrol Patch,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oyster Shell Calcium,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pancrease Ec Caps,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil 20 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil Cr 12.5,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pepcid  Complete,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Periactin 4 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peridex 473ml Sol,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perparation-H Ointment,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perphenazine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan Supp,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytek 300mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pindolol 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plaquenil 200mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plavix 75mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pletac 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pletal 100mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potass Cl Meq,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravachol 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravachol 20 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravachol 40 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Precose 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisolone Acetate,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prelone 5mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Premarin Vag Cream,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Preservision Softgel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prevacid 15mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prevacid 30mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prevastatin Sod,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prisolec Otc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pristiq 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 "," $1,002.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 "," $1,815.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine Supp,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proscar 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prostate Formula,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protocream Hc 30gm,,,,, $440.00 , $440.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protonix 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protonix 40mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Provera 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Provigil 200 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prozac 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prozac 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyridoxine 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Questran Pckt 9g,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinapril 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinapril 20mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinapril 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinidine 200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ramipril 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rampipril 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranexa 500 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rapamune 1 Mg,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Razadyne 12 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Razadyne 8 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Refresh Eye Drops,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Relafen 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Remeron 15 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Remeron 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Remifemin Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reminyl 12mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip .25 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip 1mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Restoril 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rezadyne 4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rhinocort Agua,,,,, $378.00 , $378.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $932.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 1mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 2 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 4 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $946.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperidone .25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperidone .5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperidone 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperidone 4 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ritalan 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Robitussin 5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Robitussin Dm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole .25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole HCL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rozerem 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Saphris 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Saphris 5 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senna Gen Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senna Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sennalax-S Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senokot 187mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Septra Ds,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Serevent Disl Inh,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroguel 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 300 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Serzone 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shopax 100 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinemet 25/100,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinemet 25/250,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Singulair 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skelaxin 800mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slow Fe 160mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slow K-8 Meq,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sonata 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sonata 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spiriva 18mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spiriva Handihaler,,,,, $429.00 , $429.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spiriva Refill,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $660.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ssystane Eye Drops,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ST John's Wart,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Starttera 40 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stool Softner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Strattera 25 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stress W/Zinc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sumatriptan Succ,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Super Thera Vite Mt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Symbicort 80 4.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Symbyax 6/25mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Symmetrel 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid .05 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid .2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tamoxifen 10mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tapazole 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tarka 2/240,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tears Pure,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegretol 200mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tekurna 150 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Temazepam 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Temazepam 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tenex 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tenormin 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tenormin 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terazosin,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terazosin 5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terbinafine HCL 250,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theo-24 200 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theo-Dur 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theophylline 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theragran M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Therapeutic M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thermotab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiamin 50 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiamine 100 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid 2 Gr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tofranil 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tofranil 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topamax 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topiramate 100 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toprol Xl,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Torsemide 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Torsemide 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Traqzadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazadone 150 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tricor 145mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trileptal 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trilipix 45 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trimpex 100 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tums 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tussin Cough 8oz,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uloric 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ultracet 37.5/325,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ultram 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uniphyl 400mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Univasc 15mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urecholine 25mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uroxatral 10mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vantin 200 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vasotec 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vasotec 5mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil 180 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vesicare 5mg,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Viactiv Chew Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vicon C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vigamox Drops,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Visken 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin A,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B-1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D 400 U,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Volaren 1% Gel,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Voltaren 75mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Water 45 M,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Welchol 625 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Women's One A Day,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xarelto 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Z0cor 20mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zanaflex 4mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zantac 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zelform 6 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zestril 10 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zestril 20mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zestril 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zetia 10 Mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ziac 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc 50mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc Gluconate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zithromax 250 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zocor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zocor 40mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zocor 80 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zofran 4mg Tab,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zoloft 100 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zoloft 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zoloft 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zolpidem Tartrate,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zonegran 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zonisamide 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zovirax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyloprim 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyloprim 300mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 15mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexia 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyrtec 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 2 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acamprosate Calc 333,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accupril 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accupril 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accupril 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accuzyme Oint,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $559.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $632.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adderall 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adderall 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advair Diskus 100/50,,,,," $1,128.00 "," $1,128.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advair Diskus 500/50,,,,," $1,855.00 "," $1,855.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advair Hfa 115/21,,,,," $1,391.00 "," $1,391.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advil Congest Rel,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Advil Pm,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Afrin  .05 Spr,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alaway Eye Drops,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 2mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol Inhaler,,,,, $293.00 , $293.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aldactone 50 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alendronate 35 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aleve 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allegra 60 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allopurinol 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $460.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Altace 1.25 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Altace 10 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amaryl 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $613.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amikacin 500 Inj,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlactin Lotion,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amloride 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin 500mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anikacin Inj 250,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apresoline 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 "," $1,656.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arava 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aripiprazole 15mg,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Armour 90 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aromasine 25 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Artificial Tears,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $742.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aspercreme,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Astelin Nasal Spray,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atacand 8g,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atenolol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ativan 0.5 Im,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 "," $1,242.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $711.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Augmentin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avandia 8 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $733.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ayr Nasal Mist,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azilect 1 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azmacort,,,,, $607.00 , $607.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azopt Drp 1%,,,,, $482.00 , $482.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Azor 5/40 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacid Capsules,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Baclofen 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Baclofen 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Baclofen 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacmin Tab 1,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $680.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bee Pollen,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benadryl Crm 2%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benicar 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benztropine 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betamethasone Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betoptic S Ophth,,,,, $480.00 , $480.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 "," $1,129.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biotene Mouthwash,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisacodyl 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brimonidine 0.2%,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brintellix 10 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 "," $1,086.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bystolic 10 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bystolic 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calan 80 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcarb 600 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitrate 600 + D,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Carb 600mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calmoseptine Pks,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Caltrate 600 Plus,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardizem 30 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardizem 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardura 1 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardura 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carmex Lip Ointment,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Casodex 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefpodoxine 200,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftin 500 Mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cefzil 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celestone 2 ML Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celexa 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celexa 15 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celexa 40 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cellurisc 1%,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Century Senior Vitamin,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Century Vite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cepacol Throat Spray,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cephalexin Monohydra,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cerefolin,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cerefolin Nac,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cetaphil 80z,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chantix .5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chantix 1 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholestyramine Powder,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chromagen Forte,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chromium 200 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $683.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Citracal Petites,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Citrucel Each Scoop,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clarithromycin 500mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Claritin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin Oint,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $385.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine 0.1,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $447.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $349.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole 1%,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clozapine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clozaril 100 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clozaril 50 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clozipine 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clozipine 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cogentin 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colace 100mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colace 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colcrys .6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colon Clenz Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $621.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Combivent Respimat Inh,,,,," $1,335.00 "," $1,335.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Complex + Msm,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coq-10 200 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coreg 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coreg 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coreg 40 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cortef 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $436.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coumadin 6 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Creon Dr 3000 U,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crestor 20 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crestor 40 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crestor 5 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytomel 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dantrolene Sodium,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Decadron 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Delsym Each Tsp,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote 1000 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote 1500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote 750 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Deplin 15 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desipramine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desloratadine 5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Desonide Lot 0.05,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexilant 30 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dexilant 60 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dextrose 50% Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diamox 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diary Digest,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diatx Tab 1,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diflucan 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diflucan 200 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin 0.1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin 0.25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $243.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin 200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin 400 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan 320 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diovan 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ditropan 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ditropan 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Docusate Calcium 240,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $121.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin 75 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duleek Met,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dulera Inhaler,,,,," $1,241.00 "," $1,241.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duoneb 3ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ear Wax Drps,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Effexor 225 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Effexor 50 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elavil 100 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $506.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elimite Cream 5%,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eliquis 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elmiron 100,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enablex 15mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril Maleate 10,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enoxaparin 100mg,,,,, $583.00 , $583.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Entacapone 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Entacort .25 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epoetin Alfa,,,,," $4,247.00 "," $4,247.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estroven Weight Mgt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Etodolac 100mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Etodolac 400 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ex-Lax,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fanapt 1 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fanapt 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fanapt 4 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Felcainide 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feldene 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Felodipine 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fenofibrate 145mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feogen Ga,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fergon 27 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fergon 324 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flagyl 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flecainide 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flector 1.3% Patch,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flexeril 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flexeril 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Florajen Acidophilus,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Floranex Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Florastor 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flovent Hfa,,,,," $1,507.00 "," $1,507.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $625.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folacin B/6/B12,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folbee Vitiamn,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folbic,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foltanx 90 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foltrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $284.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Freshkote Eye Drps,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Furosemide 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fycompa 8 Mg,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabitril 16 Mg,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabitril 6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabitril 8 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gas X 180 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gaviscon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 10 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 10mg Injection,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 30 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glcagon Inj,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide 15 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glipizide 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucophage 250 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Tablets,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide 3 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gs Century Vits,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $58.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gynalotrimin,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hematogen Capsule,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemocyte Plus,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hum Benzoin Compound,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocort 2.5%,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $684.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,I Car-C Plus Sr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,I Vite,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Icaps M/V (Eye),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Imdur 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Imipramine 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inderal 25 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indocin 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indomethacin 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insta Glucose Gel,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Instaflex Joint Support,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Integra Vit,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 "," $2,076.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Invokana 100 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Jantoven 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Januvia 100 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Januvia 25 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,J-Tan D Sr,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K Clor 8 Meq,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K Dur 20 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K Dur 30 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K Dur 40 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K Phos,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 10 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kcl 8 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keppra 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keppra 750 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Klonopin 2 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Klor Con 10 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Klor Con 20 Meq,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Labetalol 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Labetalol 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lacrilube Oint,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactaid,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactinex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactulose 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamictal 200 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $171.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamisil,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamisil 250 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamotrigine 25mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lanacane Compound Oint,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Latuda 20 Mg,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Latuda 80 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $972.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levaquin 750 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levemir Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levemir Flexpen,,,,," $1,510.00 "," $1,510.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothroid .15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothryoxine 88mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lexapro 15 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lexapro 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lexapro 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Librium 5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipitor 80 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium Carbonate 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Livalo 2 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lodrane D24,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loperamide 2 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lopressor 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lopressor 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 2.5/500,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Losartan 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Losartan 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Losartan 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotemax Opth 5%,,,,, $657.00 , $657.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotensin 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotensin 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotensin 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loteprednol Drop,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovaza Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loxapine 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loxapine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $692.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lyrica 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lyrica 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lyrica 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maalox 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medical Food 1 Tab,,,,, $188.00 , $188.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace 60 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 "," $3,406.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megestrol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Melatonin .75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Melatonin 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Memantine HCL 10mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mestinon 60mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metafolbic Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metalozone 5 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metamucil Cap,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metanx 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin 250 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin 600mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methadone 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methadone 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metronidazole 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 "," $1,011.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Micardis 80 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midodrine 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Midrin Capsules,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Minipress 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Minocycline 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirapex 1 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mobic 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Modafinil 200 Mg,,,,, $47.00 , $47.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Monopril 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Montelukast 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine 15 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucinex D,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multaq 400 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multivitimine,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mylanta 15ml,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mylanta 30 Cc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mylanta Bottle,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mylicon 125 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nalfon 400 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naprelan 375 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen 375 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen 550 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Narco 10/325,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Narco 5/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasal Crom Spray,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nauzene,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neosporin,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neurontin 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neurontin 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neurontin 800mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neurontin 900 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neutro Phos 250mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Niacin 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine Transdermal,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nisoldipine 20mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitrolingual Spray,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norco 5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norflex 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin 100units,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolog Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Novolog Flexpen,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuedexta 20/10,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $319.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ocean Mist,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ocean Nasal Spray,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ointment 120 Com,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 5mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Omeprazole 10mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Onfi 10 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Onglyza 5 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Opcon A Eye Drops,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Optive Eye Drops,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Os Cal 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Osphena 60 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone 5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paceron 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paceron 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pamelor 50 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pamelor 75 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pancrelipase 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pangestyme Ec,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pataday Eye Drops,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Patanase Nasal Spray,,,,, $535.00 , $535.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Patanol,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $774.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paxil 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pentazocine Nalox,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pepcid 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pepcid 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Percocet 3.75/250,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Percocet 5/325,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peri Colace,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Periactin 2 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phazyme 180 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenergan W Codine,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital 60mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phentermine 37.5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pioglitazone 30mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pioglitazone 45mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plagic 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plavix 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plendil 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plendil 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ployethylene Glycol,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pneumonia Vaccine,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Ch 10meq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Phos 250,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prandin 1 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravachol 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prazosin 1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prazosin 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prazosin 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 30 ML,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prednisone 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pregabalin 25mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pregabalin 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Premarin .9 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Premarin 0.3,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Premarin Cream 30g,,,,, $978.00 , $978.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Preparation H Supposority Box,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Preservision Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prevalite Powder,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prilosec 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Primidone 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Primidone 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pristiq 100 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proamatine 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proamatine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Probenecid Colchicicine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 "," $1,277.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $725.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $274.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prograf 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prometrium 100 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promod 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol 80 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prosight,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prostat 30 Cc,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Provera 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Provigil 100 Mg,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prozac 40 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $432.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prozosin 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Psyllium See Pack,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $656.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulmocare Nutrition,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyridium 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Qnasl Nas Spray,,,,, $700.00 , $700.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Questran 2 Gm,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Questran 9gm Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinidex 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Qvar Inhal,,,,, $825.00 , $825.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ramipril 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Refresh Pm Ointment,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 "," $4,243.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Remeron 45 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renvela 800 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip .125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip 0.5mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip 4 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Resperdol 1 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Restasis 0.5%,,,,, $815.00 , $815.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Restoril 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rifampin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risamine Oint,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $257.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal 6 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $766.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 "," $1,716.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 "," $2,250.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 "," $3,147.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperidone 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Risperidone 3 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ritalin 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ritalin 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ritalin 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rivastigmine 3mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Robaxin 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Saline Flush,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sam E 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sam E 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sanctura 20mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Santyl Top,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Savella 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Selenium Shampoo,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senna 8.6mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sensipar 30 Mg,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Serax 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 500 Mg,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel 75 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sertraline 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sertraline 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Silenor 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Silvadene Cream,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Silversulfadiazine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simethicone 80 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinemet 12.5/50,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinex Nose Spray,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Singulair 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sotalol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sotalol 80mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spiriva Inhaler,,,,, $444.00 , $444.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sporanox 100 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sps Suspension 60ml,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stalevo 100 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stalevo 150 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stalevo 50 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stalevo 75 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Starlix 60 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stelazine 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stelazine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $134.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sudafed 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sudafed 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sular 17 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sular 34 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sumatriptan 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sumatriptan 25mg,,,,, $427.00 , $427.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Surmontil 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 "," $1,384.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 "," $1,029.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tagamet 400 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tamiflu,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tapazole 10 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tapazole 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tarvatan Drops,,,,, $514.00 , $514.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tavist,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegretol 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegretol 300 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegretol 400 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tekturna 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tenex 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terazosin 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theophylline 400 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theraseal Hand Cream,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tiagabine 4mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ticlid 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tigan 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tinactin Spray,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobradex Eye Oint,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobradex Opth Drops,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $451.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topamax 200 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topamax 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topiramate  25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topiramate 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toradol 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toviaz 8 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trandate 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Travoprost Eye Drops,,,,, $538.00 , $538.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone 25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tricor 48 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trilafon 8 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trileptal 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trileptal 400 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trileptal 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trileptal 75 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trilipix 135 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trospium 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tums 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tums 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tums 650 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Turmeric Curcumin,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol 325 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol 650 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol Pm,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ultracet 100,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urecholine 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urelle Tablet,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uricholine 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urimar-T Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ursodiol 300mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valisone,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valium 5 Mg Im,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid 125mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid 500mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valsartan 160,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valsartan 320 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valsartan 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valtrex 500 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $238.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil 80 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vesicare 10mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Viamin B Complex Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Viamint E 200iud,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Victoza Epipen,,,,, $821.00 , $821.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Victoza Pen Bx,,,,," $2,143.00 "," $2,143.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Viibryd 40 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vimpat 100 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vimpat 200 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vimpat 50 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Visine Eye Drops,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vistaril 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B3 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Vitamin D 50,000",,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vivactil 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vivactil 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Voltaren 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Whey Protein Isolate,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xarelto 15 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xarelto 20 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $276.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xopenex Inhaler,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Z-Gen,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zioptan Eye Drops,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zithromax 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zocor 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zofran 8 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zoloft 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zoloft 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zolpidem Cr 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $982.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zpak 250 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyrtec 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zyvox 600 Mg,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Torsemide 5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Candesartan 8 MG,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orap 1 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $197.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Norvasc 5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CEROVITE SR TABS,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BUPROPION 75 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,venlafaxine 25 mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 "," $1,474.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VYVANSE 50 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $362.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $631.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 "," $1,062.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 "," $1,405.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $3.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $728.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ULORIC 80 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CREON 12000 U,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BRILINTA 90 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FUSION PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FOLBEE PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 "," $1,194.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LINZESS 145 MCG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LATUDA 60 MG,,,,, $144.00 , $144.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,INVOKANA 300 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VIMPAT 150 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DILANTIN 30 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PREPARATION H SUPP,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,REXULTI 1 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FARXIGA 10 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,REXULTI 2 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MELATONIN 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $816.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FETZIMA 40 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FETZIMA 80 MG,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NAPCON A SOL,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MELATONIN 0.5,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $787.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LIVALO 4 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 "," $1,538.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $193.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 "," $1,766.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $199.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FE C TAB 100,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mybetriq 25 mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $1.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $2.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $79.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AZOR 10/40 MG,,,,, $49.76 , $49.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LABETALOL 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 "," $2,517.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CREON 6000 U,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,REXULTI 3 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $20.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 "," $1,109.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $3.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $3.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $52.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $6.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $34.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $68.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ATRIPLA,,,,, $399.80 , $399.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $13.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $1.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $1.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $3.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $59.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $818.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $61.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $1.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $4.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $131.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $51.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $3.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $445.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $2.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arginaid Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $525.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 "," $1,992.40 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coban,,,,, $10.32 , $10.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Descovy 200 25 mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $291.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estroven 1 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lamicatal 200 mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lisinopril 15 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $51.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $33.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $7.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metoprolol 100 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $165.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebivolol 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pataday 2% (bottle),,,,, $594.00 , $594.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pataday 2% (drop),,,,, $19.80 , $19.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $3.75 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $11.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Primidone 150mg,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Propranolol 20mg,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Requip 3mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Salagen 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tivicay 50 mg,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toprol 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Torsemide 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tresiba (unit),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Warfarin 40mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zocor 20mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zocor 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zoloft 200mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zonisamide 75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Naproxen 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinemet 50/200mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $63.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $3.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $540.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tandem Plus Capsule,,,,, $6.96 , $6.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $28.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $2.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LATUDA 10 MG,,,,, $99.91 , $99.91 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MULTILEX,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $202.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $195.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $13.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $7.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $31.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $26.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $9.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $188.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $1.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LINZESS 290 MCG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $2.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $113.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $2.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $37.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $21.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $5.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $14.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $257.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $56.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $55.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $23.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $43.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $17.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 "," $1,548.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pentasa 500 MG,,,,, $29.32 , $29.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CENTRATEX,,,,, $4.48 , $4.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $11.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $5.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $9.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $55.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,REXULTI 4 MG,,,,, $184.68 , $184.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $8.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $148.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $2.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $58.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $8.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $6.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $172.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,SALSALATE 500MG,,,,, $71.22 , $71.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $100.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $34.17 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $48.75 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $81.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $15.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuplazid 34 mg,,,,, $304.74 , $304.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 "," $1,108.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $8.29 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $122.61 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Infusion Therapy,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 "," $2,108.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $421.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $844.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $231.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,10ml Control Syringe,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,14fr Stylet Slip,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,21 Lnr Ps,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $189.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,300cc Collection Canister,,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,48  Press Moniter Line,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adapter T,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Air Hose Disposable,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Air Hose Reusable,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alcohol Prep Pads,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Algidex Ag Gauze,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Reflux Filter,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antifungal Cream,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antireflux Filter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bacteria Filter,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Scissors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $38.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Surepress Compression,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Barrier Film,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bed Air 48,,,,, $119.78 , $119.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bed Air 48  Turning,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betadine Sol 8oz,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Betadine Swabsticks,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bite Block,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $359.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bottle 100ml Saline,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bp Cuffs Medium,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bracket  Mounting,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Bridge,suture Retention",,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brief Adult Large,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bucks Traction Boot,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calazime With Olivamine,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cannula Etc02,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Cap, Trach",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carafe With Straw,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $57.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter Connector,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter Connector (Blue),,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter IV,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter Stabilization Device,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Centerpointlock Pouch,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 "," $1,068.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Tube Tray,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Clamp, Beta",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Clamp, Occluding",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Cold Pack, Instant",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $27.15 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Commode Containers,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cone Finger Separater,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cooling Blanket,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Cover, Probe",,,,, $76.32 , $76.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $259.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cup Medicine,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debridement Tray Gss,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Del Clamp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digital Termometer,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dispo-A-Probe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Disposable Headstrap,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Disposable Lead Wires,,,,, $261.82 , $261.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drain Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $58.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dycem Matting,,,,," $1,064.24 "," $1,064.24 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Edema Gloves 1ea,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Expiratory Filter,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 "," $2,764.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flexiseal Bag,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flexiseal Management System,,,,," $2,640.46 "," $2,640.46 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $10.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Forceps, Adson",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Full Face Mask Large,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Full Face Mask Medium,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Full Face Mask Small,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gair Built Blue,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $323.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Geri Chair Cushion,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gloves Large Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gloves Medium Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucerna 1.2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hair Brush,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Pitt Padded,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemostat Absorbable,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,High Flow Humidification Syste,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hip Kit,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hot Packs,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrogen Peroxide,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $135.21 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ioban Steri Drape,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Start Kit,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kerlix Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kit Suture Removal,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $157.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $220.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 "," $1,022.90 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee Support Brace,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Label IV Day of Week,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $97.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Large Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liquid Skin Protectant,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lotion Hand/Body,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $103.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Male External Cath-Medline,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask, Ear Loop",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask, Full Face Large",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask, Full Face Small",,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask, Nasal Small",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Med Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meplix Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Odor Eliminator Scented,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oral Care Kit,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Pack, Basic",,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Palm Cups 60mm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Palm Grip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Passy Muir Valve,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Petroleum Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pneumothorax Set,,,,," $1,244.44 "," $1,244.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Port Protector,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $118.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 "," $1,866.07 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 "," $2,014.04 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pressure Port for Therapep,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $101.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Razors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reacher 32,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ready-Bath,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rectal Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $596.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Set Catheter Irrigation,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoe Horn Long 24,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoulder Immobilizer,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shower Caps,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skin Closure Strips,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $42.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Soap Deodorant,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Speicmen Collection Commode,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spenco Boot--Outer,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Saline 100ml,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Sheets,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Water 1000ml,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suction Canister 1200cc,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suction Canister 2400ml,,,,, $34.98 , $34.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 "," $1,417.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suture Removal Kit,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 20cc Ll,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Syringe, Insulin",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tape Durapore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tape Measure,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tape Micropore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tape Transpore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tape Transpore 2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $186.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theraband Green,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Therapep,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theraputty Red,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theraputty Yellow,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thick & Easy,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thigh Garment Scd,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tongue Blade,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trac Y Connector,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $44.37 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Tray, Percutaneous",,,,, $629.64 , $629.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tubing Corrugated,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $18.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinal Female Guardian,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinal Male Supreme,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vac Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vent Circuit,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vest Starter Kit,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Viscopaste Pb7,,,,, $109.18 , $109.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitalstim Therapy,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Water Pitcher 22oz,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wedgesx2,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Weighted Bendable Fork,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wing Infusion 22inch,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Winged Infusion 20in,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $239.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adult Wipes,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alcohol Preps,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alldress Dressing,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Catheter,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arm Sling,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Baby Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandaid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Briefs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Comb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Connecting Tube,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Denture Adhesive,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Denture Cup,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Deodorant,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dressing Change Charge,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duoderm Dressing,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,E Cylinders,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enema Bag With Soap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ensure,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Extension Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feeding Set,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fleets Enema,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucerna,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Strip,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Graduated Container,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gt Bag,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hair and Body Shampoo,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heel Protectors,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hibiclens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Hose, Care Knee",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Introcan 22g 1 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kerlix,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kleenex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lancet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lice Treatment,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lip Balm,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Messengile Douche,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mouthwash,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nail File,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasal Cannula,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebulizer,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,No Rinse Shampoo,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,O2 Concentrator,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perineal Cleaner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Posie Pads,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Q-Tips,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shave Cream,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skin Prep Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Slipper Socks,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Soap Bar,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Speci-Hat,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Specimen Container (Sterile),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Staple Remover Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe With Needle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Telfa Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thick It,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toothbrush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toothette,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toothpaste,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tubing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Underpads,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinal,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vaseline,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vial Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vista Pump,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vista Pump Set,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wash Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Water Pitcher,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wound Cleaner,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wound Gel,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Emery Board,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Emesis Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,2 3/4  Wafer,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"4"" Kerlick",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"4""drainable Pouch",,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ace Bandage,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adult Pullups Large,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adult Pullups Medium,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adult Pullups Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bed Pan,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ben Gay,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Briefs Extra Large,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Briefs Large,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Briefs Medium,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Briefs Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Butterfly Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Autoguard 20,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Catheter, Condom",,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Catheter, Foley",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clean Catch Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colostomy Pouch,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Denture Brush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ensure Shake,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enteral Feeding Kit,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $822.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heel Suspension Boot,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Horizon Tubing,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hoyer Lift Pad,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydrogel Dressing,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ileostomy Bag,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Incentive Spirometer,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulated Water Carafe,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iodine Prep,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Pump Daily,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lubricating Jelly,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lubriderm,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medseptic Packet Each,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebulizer W/Mask,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nizoral Shampoo,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Non Adherent Pads,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ocean Spray,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Paper Tape,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Personal Belonging Bag,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Resource 8 Oz Can,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sarna Lotion,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Selson Blue Shampoo,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Speciman Cups,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Straight Catheter,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suplena 120 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 12cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 1cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 3cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 5cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ted Hose Knee High,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ted Hose Thigh High,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tinactin Powder,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Unna Boot 4""",,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vaseline Pkts,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wafer,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bariatric Bed,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Air Mattress,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trapeze Bar,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wound Vac,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bariatric Lift,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CATHETER MIDLINE,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Catheter, short term, straight",,,,," $2,543.00 "," $2,543.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blanket Bair Hugger,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,STERILE CAP MALE,,,,, $0.50 , $0.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 "," $2,713.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,B.D. Neelde,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Distilled Water,,,,, $11.19 , $11.19 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Steri Strips,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sling Arm Large,,,,, $28.18 , $28.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Collar Cervical,,,,, $84.62 , $84.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoe Post OP,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Boot Ankle Contracute,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Belt Gait 60inch,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Decannulation Plug,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $41.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abduction Wedge,,,,, $551.60 , $551.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Airway Guedel 70mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Airway Guedel 80mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $8.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Surgitube Large,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Surgitube Small,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $282.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee Immobilizer,,,,, $271.24 , $271.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $79.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $26.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $40.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $259.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $259.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $27.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $16.35 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Admission Set Up,,,,, $831.04 , $831.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cannula High Flow,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coloplast Clamps,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Control Mitt,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Isosource,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Jevity,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Juven,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Nepro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Oxepa,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Prostat,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $219.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trapeze Free Standing,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Central Line Dressing Kit,,,,, $822.48 , $822.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eclipse Injection Needle,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humid Vent 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aldosterone Bld,,,,, $938.10 , $938.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amitriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Huab,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Yob,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Benzodiazepines,,,,, $302.10 , $302.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamezipine Free,,,,, $237.44 , $237.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath for Collection,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPT Initial,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPT Subsequent,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiv-1,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lead Urine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Manual Differential,,,,, $623.28 , $623.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Microalbumin Urine,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myoglobin,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Parvo Virus Igg,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Parvo Virus Igm,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 "," $1,968.42 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $68.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protime,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $215.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Smear Nasal Eos,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sputum Collection,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinalysis Dipstick,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venipuncture,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,West Nile Virus Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,340 Measure Volume,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Afb Culture,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Afb Sensitivity,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ANA Titer & Pattern,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Scl 70,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antigen Type,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aso Titer,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bld Type Du,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Marrow Studies,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CBC With Auto Diff,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cell Count Csf,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlamydia by Probe,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlamydia Group Ab,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $549.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cmv Igm Ql,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crystal ID Synovial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Directogen Serum,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eosinphhil Count,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epstein Barr Ea,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epstein Barr Ebna,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epstein Barr Vca,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Era,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Febrile Agglut Each,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fecal Fat,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fibren Split Product,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fibrinogen Quan,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flow Cytometry Dna,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,H Pylori,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Handling Fee,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemo Influenza,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $348.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiv,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiv Viral Load,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiv Western Blot,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Holter Monitor 24hr,,,,, $414.00 , $414.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hpv Culture,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iep Except Serum,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iep Serum,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kell Ag Titer,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lupus Anticoagulant,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Manuel Diff,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metanephrines Urine,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Misc Immun Proc,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ob Screen,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Occult Blood,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ova Paras Smears,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pertussis Smears,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Cnt,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Count Auto,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pra,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein Electrophore,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rapid Group A Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rapid Group B Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Retic Absolute,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $397.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rocky Mountain Igg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,RPR,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,RPR Titer,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,RSV,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,SED Rate,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Semen Analysis Compl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Semen Post Vasectomy,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sickle Cell Prep,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Smear Review by Path,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urea Breath Collect,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinalysis,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinalysis Chem Only,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urine Immun Fixation,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urine Microscopic,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Varicella,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,WBC,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,West Nile Igm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wet Mount,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $546.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $701.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $719.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ova Parasites Ocp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $839.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urine 24 Hour,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urine Culture,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,WBC W Differential,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT/INR,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TPA tissue plasminogen,,,,, $136.12 , $136.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Acetone, Quant",,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Actaminophen,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acth,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acth Treatment,,,,, $467.46 , $467.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albumin Body Fluid,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alcohol Blood,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alcohol Urine,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aldolase,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $443.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alkaline Phosphatas,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amikacin,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amiodorone,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ammonia Blood,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amphetamine,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amylase Body Fluid,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amylase Isoenzyme,,,,, $723.98 , $723.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amylase Serum,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Androstenedione,,,,, $929.62 , $929.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antidiuretic Hormone,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antihistone Ab Quant,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apolipoprotein A,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apolipoprotein B,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arsenic Any Source,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,B Naturetic Peptide,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Barbiturates Quant,,,,, $445.20 , $445.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Basic Metabolic Panel,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bilirubin Direct,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bilirubin Total,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bupropion,,,,, $587.24 , $587.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,C Peptide,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Blood,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Ionized,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcium Urine 24,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carbon Diox Co2,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carboxyhemoglobin,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Carotene,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Catecholamines Total Urin,,,,, $710.20 , $710.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CEA,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ceruloplasmin,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chloride 24hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chloride Blood,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chloride Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholesterol Hdl,,,,, $201.40 , $201.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholesterol Total,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholinesterase Rbc,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 "," $1,577.28 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chromatography Quant,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Comp Metabolic Panel,,,,, $684.76 , $684.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Copper,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cortisol Am,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cortisol Pm,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cortisol Serum,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPK Isoenzymes,,,,, $412.34 , $412.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPK-Mb,,,,, $354.04 , $354.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $214.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Creatinine Clearance,,,,, $286.20 , $286.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Creatinine Serum,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Creatinine Urine Random,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cryoglobulin,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyanide,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyclosporine Level,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cystine Urine 24hr,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diazepam Assay,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Digoxin Lab,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dimeric Inhibin A,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doxepin (Sinequan),,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drug Screen Urine,,,,, $619.04 , $619.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Drug Screen:confirmation,,,,, $196.10 , $196.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D-Xylose,,,,, $526.82 , $526.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electroholresis-Serum,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electrolyte Panel,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Enzymatic Digestion,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Erythropoietin,,,,, $848.00 , $848.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estradiol Serum,,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estriol Unconjugate,,,,, $263.94 , $263.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estrogen Total,,,,, $694.30 , $694.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estrone,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fecal Fat Quant,,,,, $539.54 , $539.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fecal Fat Screen,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ferritin,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Folic Acid Rbc,,,,, $337.08 , $337.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Folic Acid, Serum",,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $607.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $474.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastrin Serum,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,General Health Panel,,,,," $1,186.14 "," $1,186.14 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gentamicin Level,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ggt,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucometer Lab,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose G6pd,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Random,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $64.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucsoe Blood,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Haptoglobin Quant,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemoglobin Electroph,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemoglobin Plasma,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemoglobin Urine,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemosiderin,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatic Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitus Panel,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Homocystine Serum,,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxyproline Free,,,,, $986.86 , $986.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immunoglobulin E,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $744.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immunolgobulin Igo,,,,, $677.34 , $677.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Impramine,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Total,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intrinsic Factor,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iron,,,,, $170.66 , $170.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iron Binding Capacity,,,,, $54.06 , $54.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketone Serum,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,L/S Ratio Quant,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactoferrin by Eia,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LDH Body Fluids,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LDH Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LDH Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lead Blood,,,,, $304.22 , $304.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lidocaine,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipase,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lipid Profile,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lithium Quan,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loh Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Loh Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Luteinizing Hormone,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Magnesium,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mercury,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $692.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methadone,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $728.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Microalbumin,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $603.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myoglobin Urine,,,,, $497.14 , $497.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Niacin Level,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nicotine,,,,, $243.80 , $243.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Noratriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nucleotidase 5,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Occult Blood Gastric,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Occult Blood Stool,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oligoclonal Bands,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Opiates Quantitative,,,,, $278.78 , $278.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Osmolality Blood,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Osmolality Urine,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Parathyroid Hormone,,,,, $422.94 , $422.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $409.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pcr Amplification,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ph Body Fluid,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenobarbital,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin Free,,,,, $536.36 , $536.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phosphatase Acid Total,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phosphatydylglycerol,,,,, $696.42 , $696.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Porphob Urine (Quant),,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Random Urine,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Serum,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pre Albumin,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Primidone (Mysoline),,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Procainamide,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Proclactin,,,,, $509.86 , $509.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Progesterone,,,,, $410.22 , $410.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein 24hr Urine,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein Phoresis Serum,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein Phoresis Urine,,,,, $345.56 , $345.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein Random Urine,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein S Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein Total,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PSA Total,,,,, $399.62 , $399.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pseudocholinesterase,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Quinidine Level,,,,, $358.28 , $358.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reducing Substance Stool,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renal Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Salicylate,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 "," $1,499.90 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sgot or AST,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sgpt or ALT,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Body Fluid,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Serum,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sodium Urine,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Specific Gravity -Other,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stone Analysis,,,,, $349.80 , $349.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stone Analysis Quan,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stone Rosk Citrate,,,,, $490.78 , $490.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stool for Reducing Substances,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,T-3 Free,,,,, $966.72 , $966.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,T-3 Resin Uptake,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,T-3 Total,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tacrolimus,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Testosterone Free,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Testosterone Total,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Theophylline Level,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thiamine Vit B1,,,,, $614.80 , $614.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroxine Free T4,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroxine Total T4,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tibc Without Iron,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tobramycin Test,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transferrin,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trazodone,,,,, $579.82 , $579.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tricyclic,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Triglycerides,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Troponin Quantitative,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Trypsinogen Serum,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tryptase Serum,,,,, $651.90 , $651.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tularemia Agglutinins,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uric Acid Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uric Acid Serum,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vancomycin Test,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vasopressin,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin A-Test,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B12,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $925.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin C Blood,,,,, $625.40 , $625.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 "," $1,055.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 "," $1,023.96 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin D Level,,,,," $1,085.44 "," $1,085.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vitamin E Serum,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vma Urine 24hr,,,,, $487.60 , $487.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Volatiles,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zinc Serum,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renin,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Acetylcholine Recep,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Albumin Serum,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amniostat,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti-Histone Abs,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Barbiturates Confir,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chloride Urine,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholinesterase,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Creatinine Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dhea S Serum,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Estrogen Level,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eth0suximide,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ethylene Glycol,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gloucose Body Fluid,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose 5 Hr,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glucose Whole Blood,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiaa Urine,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Iron Serum,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,L/S Ratio,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lactic Acid,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,LDH,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ldl Measured,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liver Profile,,,,, $521.00 , $521.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Methylmalonic Acid,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Misc Chem/Tox,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Osullivan,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Phosphorus Serum,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Potassium Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PSA Free,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Topiramate Quant,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Uric Acid Urine,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vma Urine,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Keppra Serum,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ketosteriods,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liver Function Test Lft,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ab Encephalitis California,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Adenovirus Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $175.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $498.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Aspergillus,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Blastomycosis,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Brucella,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Coccidioides,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Dna,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Elution,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $592.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Leptospira,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Rpn,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Sjogren,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antiphospholipid,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aso Screen,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bartonella Antibody,,,,, $662.50 , $662.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bences Jones Protein,,,,, $449.44 , $449.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blood Typing Rh (0),,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blood Typing Rh (D),,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bordetella Pertussis,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brucella Obortus,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,C Reactive Protein,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,C1 Esterase,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ca 125,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ca 15-3,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ca 19-9,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ca 27-29,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Calcitonin,,,,, $390.08 , $390.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cardiolipin Antibody,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Celiac Disease Antibod,,,,," $1,424.64 "," $1,424.64 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cell Total Count,,,,, $636.00 , $636.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlamydia Antibody,,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cie,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clotest/Culture Urine,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Complement Antigen,,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Complement C1 Function,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Complement C3 Antigen,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Complement C4 Antigen,,,,, $89.04 , $89.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Complement Total (Ch 50),,,,, $597.84 , $597.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crp Ultrasensitive,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cryptococcal Antigen,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytomegald Igg,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Direct Coombs,,,,, $137.80 , $137.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dna Antibody Single,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Du Typing Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ehrlichia Titer,,,,, $217.30 , $217.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Encephalitis East Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Encephalitis ST Louis,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epstein Barr (Ea),,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feb Agglut Ea,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feb Agglut Papa A,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feb Agglut Typh D,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Feb Agglut Typh H,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Frozen Blood Preparation,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fta-Abs,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $342.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $356.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis C Antibody,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis C Riba,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Herpes Simplex Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Herpes Simplex Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heterophile Abititer,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hla Typing B27,,,,, $649.78 , $649.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immundelectrophoresis,,,,, $363.58 , $363.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $546.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Islet Cell Antibody,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Legionella Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $310.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lyme Disease Antibody,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mhatp,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mitochondrial Antibody,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mono Test,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mumps Antibody,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Antibody,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pneumococcal Abs,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pooz Echinococcus,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Processing Autologous,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ra Titer,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rh Phenotyping,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $508.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rotavirus,,,,, $569.22 , $569.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rubella Igg,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rubella Specific Igm,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rubella Titer,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scheroderma Antibody,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $463.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 "," $1,043.04 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroglobulin Antib,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toxoplasma Igm,,,,, $405.98 , $405.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Varicella Igg,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Varicella Igm,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rubeola Titer,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vorl-Csf,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody ID,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Screen,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crossmatch is,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antithrombin Iii As,,,,, $771.68 , $771.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apc Resistance,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aptt,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Automated Platelet Count,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bleeding Time,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CBC Complete Automated,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coagulation Time Activ,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D Dimer,,,,, $517.28 , $517.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,D-Dimer Quantitative,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eosinophil Count,,,,, $181.26 , $181.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor 8 Level,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 "," $1,073.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor Ix Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor V Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor X Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor Xi Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor Xii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Factor Xiii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fibrinogen Activity,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hematocrit,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hematocrit Spun,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemoglobin,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $332.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kleihauer-Betke,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Morphology,,,,, $520.46 , $520.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Aggregation,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Countaiuid,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Countimanual,,,,, $146.28 , $146.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Function Assay #1,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Platelet Neutralization,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein C Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Protein S Total,,,,, $855.42 , $855.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PTT Practionated,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rbc Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reticulocyte Count,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $435.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sedrate-Westergren,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,WBC Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wnc Diff Only,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Af N Men A/Y,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Afb ID Direct Probe,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aft Smear Only,,,,, $193.98 , $193.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ag N Men C/U,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clostridium Diff Tox,,,,, $712.32 , $712.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Anaerobic,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Blood,,,,, $84.80 , $84.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Body Fluid,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Cath Tip,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Chlamydia,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Csf,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Fungus (Blood),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Fungus (Skin),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Gc Definitive,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Genital,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $311.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Herpes Typing,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Non Urine ID,,,,, $81.62 , $81.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Sputum,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Stool Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Throat,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Throat or Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Urine,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Urine ID,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Viral,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Culture Wound Aerobic,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fungus Smear,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gram Stain,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $251.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $575.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis C Quant,,,,, $250.16 , $250.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $922.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Herpes Virus Isol,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Histoplasma Antigen,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $395.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $702.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,India Ink Prep,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Influenza B by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Jc Virus by Pcr,,,,," $1,089.68 "," $1,089.68 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Koh Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Legionella Antigen Urine,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Malaria Smear,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $884.04 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neutrophil Ab,,,,, $267.12 , $267.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ova and Parasites,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pinworm Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Refacid Fast Culture,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,RSV Rapid Test,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sensitivity Mic,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Strep Group A Antigen,,,,, $206.70 , $206.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,West Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cult Fungi Other,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cult Grp B Strep,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bile Urine,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bile Urine Auto,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reducing Substance Urine,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Timed Volume Measurement,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinalysis Macro Only,,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urinalysis Micro Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Indirect Coombs,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 "," $2,905.46 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $230.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clinical Consult Limited,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $149.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flow Cytometry,,,,, $577.70 , $577.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fna Evaluation,,,,, $204.58 , $204.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $532.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cytology Cell Block,,,,, $281.96 , $281.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Decalcification Procedure,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $638.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pathology Consult In Surg,,,,, $815.14 , $815.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pathology Level I,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pathology Level Ii,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pathology Level Iii,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pathology Level IV,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pathology Level V,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pathology Level Vi,,,,, $617.98 , $617.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Special Stain Group Ii,,,,, $120.84 , $120.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Special Stains Group I,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Special Stains Group Ii,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abdomen 2 Views,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abdomen 3 Views,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abdomen IV (Kub),,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abdomen IV Port,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abdomen One View,,,,, $360.00 , $360.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $869.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ac Joints Bi,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ankle Complete,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Athrect Periph Artery,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Barium Enema,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Barium Enema Red Svc,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Barium Swallow,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biliary Stone Extraction,,,,, $673.00 , $673.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Age Studies,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Density Dexa,,,,, $633.00 , $633.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Survey Limited,,,,," $1,132.00 "," $1,132.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Breast Needle Local,,,,," $1,336.00 "," $1,336.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Breast Surgical Specimen,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronchography Bi X&i,,,,," $1,106.00 "," $1,106.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $991.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 "," $1,281.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 "," $1,265.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 "," $2,238.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $852.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $670.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Clavicle Complete,,,,, $373.00 , $373.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $753.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diskographylumbar S&i,,,,," $1,339.84 "," $1,339.84 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abdomen Complete,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ankle 2 Views,,,,, $347.00 , $347.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elbow 2v Comp,,,,, $309.52 , $309.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elbow Min 3v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Embolization Therapy,,,,," $8,848.00 "," $8,848.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Embolization Therapy S&i,,,,," $5,008.00 "," $5,008.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hip Min 2v,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foot Min 3 Views,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Forearm 2 Views,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand 2 Views,,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hip Operative Proc,,,,, $939.16 , $939.16 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Min 3 Views,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $334.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hip Unilat 1 View,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $576.64 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ercp Biliry Duct,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Esoph With Video,,,,, $890.40 , $890.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Esophagus,,,,, $557.56 , $557.56 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eye for Fb,,,,, $387.96 , $387.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Facial Bone 3 Views,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Femur Min 2views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Film Copy X-Ray,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $446.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 "," $1,691.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flouro More 1 Hour,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoro Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fluoro W/O Film,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foot 2 Views,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humerus Min 2v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 "," $1,105.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $475.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ivp Retrograde,,,,," $1,017.60 "," $1,017.60 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $948.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 "," $1,013.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ivus Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee 3 Views,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee Min 4v,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mandible 1-3v,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mandible Min 4v,,,,, $545.90 , $545.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $492.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 "," $2,428.46 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 "," $2,308.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 "," $2,134.84 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Neck Soft Tissue,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nephrostogram,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 "," $1,580.46 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Optic Foramina Exam,,,,, $690.06 , $690.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orbits 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orbits 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Panorex,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pelvimetry,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 "," $1,297.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 "," $3,047.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $709.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renal Angio Bilat,,,,," $3,838.26 "," $3,838.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renal Catheter Placement,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $715.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scapula (2 Views),,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scapula Complete,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sella Turcica,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoulder 1 View,,,,, $374.18 , $374.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sialography S&i,,,,, $601.02 , $601.02 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinuses <3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinuses 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinuses Waters View,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skull 1-3 Views,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skull Min 4v,,,,, $648.72 , $648.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Small Bowel Series,,,,," $1,602.72 "," $1,602.72 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $849.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $640.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Thoracic 2v,,,,, $570.28 , $570.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sternum 1v,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sternum 2 Views,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Subtraction Study,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Svc,,,,," $1,161.76 "," $1,161.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tmj Bi,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tmj Unilat,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Toes 2 Views,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 "," $1,619.68 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 "," $2,174.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $910.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 "," $2,999.80 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Upper Gi,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Upper Gi W/Air,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Upper Gi W/Kub,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ureter Stent Placement,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 "," $1,048.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 "," $1,495.66 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 "," $1,827.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venography Caval Inferio,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wrist 2 Views,,,,, $288.32 , $288.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xray Reading Outside,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zygomatic Arch,,,,, $393.26 , $393.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,A/C Joints Bilateral,,,,, $205.00 , $205.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ankle Ap & Lat,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Coccyx,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colon Barium,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Colon Barium W/Air,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cystogram S&i,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elbow Ap & Lat,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elbow Complete,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Elbow Complete I/F,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foot Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foot Complete I/F,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Forearm 1 Joint,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Complete I/F,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hand Two Views,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hip 2 Views I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hip Uni Two Views,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Facial Bones Comp,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Femur,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fingers,,,,, $198.00 , $198.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foot Ap & Lat,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Humerus,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee 2 Views I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee Ap and Lateral,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Knee Completed,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kub,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mandible Complete,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mandible Copl I/F,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mandible Limited,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mastoid Complete,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nasal Bones Only,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Os Calcis,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pelvis 2 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pyelogram Retro,,,,," $1,762.00 "," $1,762.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ribs Bilateral,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ribs Unilateral,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sacroiliac,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sacrum,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scapula,,,,, $216.00 , $216.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoulder 3 Views,,,,, $335.00 , $335.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoulder Compl I/F,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Shoulder Limited,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinuses Complete,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sinuses Limited,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skull Complete,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skull Complete I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skull Limited,,,,, $261.00 , $261.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $330.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Cervical Compl,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Lumb Complete,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sternaclavc Jnts,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sternum,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tempmndublr Jnts,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tibia and Fibula,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Upper Gi Series,,,,, $609.00 , $609.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venogram Unilateral,,,,," $3,111.00 "," $3,111.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wrist Ap & Lat,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wrist Complete,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bladder Scan,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Contrast Xray Uniary,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Foot Complete 3 Views,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orbit X-Ray,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 "," $3,972.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 "," $3,390.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Aortic Arch,,,,," $2,463.44 "," $2,463.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 "," $1,564.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 "," $1,187.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 "," $3,897.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 "," $1,618.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 "," $3,420.62 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 "," $2,921.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Carotid CPT,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 "," $2,033.08 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 "," $3,864.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 "," $3,117.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 "," $3,878.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 "," $3,669.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Renal Unilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Retro Brachial,,,,," $1,313.34 "," $1,313.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 "," $2,079.72 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 "," $1,248.68 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Visceral S&i,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 "," $3,919.88 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angiography Spinal S&i,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 "," $2,784.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 "," $2,119.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplasty Periph Art,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 "," $2,226.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arthrography Hip S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arthrography Knee S&i,,,,," $1,246.00 "," $1,246.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 "," $1,253.98 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Artho Shoulder,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 "," $2,454.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aorta Abdominal,,,,," $4,554.00 "," $4,554.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 "," $3,069.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 "," $3,842.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aortoram Abdominal,,,,," $1,210.52 "," $1,210.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest 1 View I/F,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Complate 4 Views,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Inspir/Exp,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Lat Decub,,,,, $438.00 , $438.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Pa 2 Views,,,,, $556.00 , $556.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Pa Single View,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Port,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest One View,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Three Views,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chest Two Views,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 "," $7,310.82 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $924.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Imaging Spect,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 "," $2,138.02 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 "," $1,503.08 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $889.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cisternography,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liver Funct Study,,,,," $2,514.32 "," $2,514.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Liver Scan (Spect),,,,," $2,047.92 "," $2,047.92 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lung Perfusion,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Lung Ventilation Scan,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 "," $1,576.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 "," $5,828.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 "," $3,110.04 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Parathyroid Scan,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Scan White Blood Cell,,,,," $3,372.92 "," $3,372.92 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 "," $2,176.18 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Schilling Test W/Factor,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 "," $1,020.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Testicular Imaging,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 "," $2,054.28 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 "," $2,684.98 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 "," $1,241.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tumor Local Spect,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tumor Local Whole Body,,,,," $2,575.80 "," $2,575.80 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastric Emptying Scan,,,,," $5,148.42 "," $5,148.42 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 "," $5,990.06 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 "," $2,805.82 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastrographin Liquid,,,,, $434.60 , $434.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Chest W/Con,,,,," $4,525.14 "," $4,525.14 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 "," $4,650.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 "," $1,108.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 "," $4,091.60 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Pelvis W/Con,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Facial W/O,,,,," $1,693.00 "," $1,693.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 "," $2,254.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 "," $7,418.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 "," $1,682.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Head W/Contrast,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Head W/O Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 "," $1,966.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Iac W/O Cont,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 "," $2,941.50 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Neck W/Contrast,,,,," $2,894.86 "," $2,894.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 "," $3,922.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $673.10 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Crystal Analysis,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Abd W/Con,,,,," $2,140.14 "," $2,140.14 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Abd W/O Con,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 "," $3,997.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Guided Needle Loc,,,,," $2,268.40 "," $2,268.40 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 "," $7,174.08 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $842.70 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 "," $1,992.80 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 "," $3,739.68 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 "," $3,963.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 "," $4,854.80 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 "," $2,595.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 "," $3,561.60 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 "," $3,587.04 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Needle Bx,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $384.78 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Extremity CPT,,,,, $961.42 , $961.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Peripheral CPT,,,,," $5,450.52 "," $5,450.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Renal,,,,," $3,396.24 "," $3,396.24 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angio Visceral CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 "," $4,096.90 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 "," $5,325.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplasty Iliac,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aorta Catheterization,,,,, $934.92 , $934.92 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aortogram Abd CPT,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Appl Unna Boot,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 "," $5,719.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 "," $3,491.64 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 "," $1,179.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherect Aorta Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 "," $3,442.88 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 "," $2,444.36 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 "," $2,200.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Lung,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $785.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $951.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 "," $1,744.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronchography Uni S&i,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 "," $2,339.42 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bx of Kidney CPT,,,,, $952.94 , $952.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 "," $3,093.08 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 "," $7,648.96 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 "," $7,369.12 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 "," $1,509.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $913.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 "," $3,933.66 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Central Venous Cath,,,,, $289.38 , $289.38 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $634.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 "," $2,374.40 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 "," $1,955.70 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Embol Extracranial CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Embolization CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $392.20 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ercp Radiology CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 "," $3,265.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $698.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,I&d Cyst Complex,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,I&d Cyst Simple,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 "," $1,930.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ins Chest Tube,,,,, $642.36 , $642.36 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insert Central Line Percu,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 "," $3,279.64 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 "," $4,208.20 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 "," $2,903.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 "," $5,344.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 "," $3,210.74 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $786.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $659.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $531.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 "," $3,668.66 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 "," $2,935.14 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 "," $2,024.60 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 "," $1,605.90 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 "," $2,245.08 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 "," $7,211.18 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 "," $3,402.60 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 "," $1,904.82 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $864.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 "," $3,612.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $899.94 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 "," $3,793.74 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Replc Picc Only Surg,,,,," $2,452.84 "," $2,452.84 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reposition Leads,,,,," $3,916.70 "," $3,916.70 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skin Biograft,,,,," $1,718.26 "," $1,718.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Skin Biograft Add-On,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Split Skin Graft,,,,," $3,782.08 "," $3,782.08 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Stent Placement,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 "," $1,386.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thoracentesis,,,,, $804.54 , $804.54 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 "," $2,257.80 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 "," $2,378.64 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 "," $2,167.70 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tissue Graft Other,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tracheostomy Planned,,,,," $3,892.32 "," $3,892.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 "," $1,170.24 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 "," $1,092.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 "," $3,390.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,General Anesthesia,,,,," $2,207.98 "," $2,207.98 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 "," $1,138.44 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $98.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Blood Admin,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Transfuse Blood Products,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Echo Routine,,,,, $768.50 , $768.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ultrasound Extremity,,,,," $1,598.48 "," $1,598.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Renal Sonogram,,,,," $1,749.00 "," $1,749.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 "," $2,414.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mammogram Special,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Echo Color Doppler,,,,, $703.84 , $703.84 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Echograhy Transrectal,,,,, $858.60 , $858.60 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 "," $1,080.14 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 "," $2,186.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Abdomen Complete,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Abdomen Limited,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Aorta,,,,," $1,011.24 "," $1,011.24 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Breast Bilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Breast Uni,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Gallbladder,,,,, $675.22 , $675.22 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 "," $6,321.84 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Kidney,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Pelvic Complete,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Pelvic Limited,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Retro Limited,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Scrotum,,,,, $747.30 , $747.30 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Thyroid,,,,, $711.26 , $711.26 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Transvaginal,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Us Chest,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Us Guide Vascular Access,,,,," $1,134.20 "," $1,134.20 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Us Kidney,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 "," $1,867.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Abg,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accapella Setup,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Accapella Treatment,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Arterial Puncture,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 "," $1,183.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronch Ther-Initial,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronch Ther-Subs,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronch With Biopsy,,,,," $1,828.00 "," $1,828.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bronch With Brushing,,,,," $1,620.00 "," $1,620.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $798.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Cpr-Code Blue,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Diag Bronch,,,,," $1,286.00 "," $1,286.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Intubation,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mdi Setup,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mdi Treatment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxygen Per Day,,,,, $359.00 , $359.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxygen Setup,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Patient Education,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peak Flow,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pft Pre & Post,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pft Simple,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulse Ox Setup,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rt Assessment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sputum Induction,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suction,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suction Set Up,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Updraft Set Up,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Updraft Treatments,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Vent Check-Daily,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPAP,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,CPAP Mask,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mdi,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Non Rebreather,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxygen Mask,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Suction Equip Daily,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Portable O2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulse Oximeter,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Prosthetic Training 15min,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Massage,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Re-Eval,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Therapeutic Proc,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT-E-Stim,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT-Wheelchair Main,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sensory Integration 15min,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Gait Training 15 Min,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Kinetic Excercises,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Evaluation,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Therap Group 15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Physical Ther. Activities,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Physical Therapy Procedures,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Evaluation/-Go,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Adl 15-Min,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $407.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $282.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Re-Eval - Go,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Tens Application - Go,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Speech Therapy,,,,, $308.46 , $308.46 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $618.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Speech Therapy Eval,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Swallow Clinical Eval,,,,, $854.00 , $854.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 "," $1,242.32 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 "," $1,745.82 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $754.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Echo 2d&m Complete,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Echo D&m Limited,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $489.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Echo Cardiogram,,,,," $4,562.00 "," $4,562.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Ambulance One Way,,,,," $1,214.76 "," $1,214.76 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Abd W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 "," $7,515.40 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 "," $6,315.48 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 "," $4,867.52 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 "," $6,631.36 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Brain W/Cont,,,,," $5,235.34 "," $5,235.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 "," $14,057.72 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Add'l Levels,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,MRI Head,,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mra Head Wo Cont,,,,," $1,312.28 "," $1,312.28 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 "," $1,906.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,General Recovery,,,,," $1,500.00 "," $1,500.00 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EKG,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EKG Rhythm Strip,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Electrocardiogram,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 "," $1,215.82 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 "," $1,196.74 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EEG Sleep Only,,,,," $1,587.88 "," $1,587.88 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 "," $1,988.56 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Mslt,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polysomnography W CPAP,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polysomnography W/4+param,,,,," $5,587.26 "," $5,587.26 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 "," $6,984.34 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EEG,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Hemodialysis,,,,, $549.08 , $549.08 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Peritoneal Dialysis,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Nursing Assessment,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Patient Education Group Sessio,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Educational 60 Mi,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Training Education 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 "," $4,011.04 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Tcp02,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,EMG Electromyograph,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in DRG
Aetna,Medicare Managed Care,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in DRG
Cigna Health Plan,Cigna,DRG,,Private Room,,,,," $1,083.00 ", $-   , $-   ," $1,374.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Cigna Health Plan,Cigna,DRG,,Semi-Private Room,,,,," $1,051.00 ", $-   , $-   ," $1,374.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Cigna Health Plan,Cigna,DRG,,ICU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,794.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Cigna Health Plan,Cigna,DRG,,CCU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,794.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Cigna Health Plan,Cigna,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ", $-   , $-   , $-   ,,,Not included in contract
Cigna Health Plan,Cigna,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ", $-   , $-   , $-   ,,,Not included in contract
Cigna Health Plan,Cigna,HCPC's,90832,Individual Psychotherapy 30 Mi,,,,, $250.16 , $-   , $-   , $-   ,,,Not included in contract
Cigna Health Plan,Cigna,HCPC's,90834,Individual Psychotherapy 45-5,,,,, $501.38 , $-   , $-   , $-   ,,,Not included in contract
Cigna Health Plan,Cigna,HCPC's,90853,Group Psychotherapy,,,,, $326.00 , $-   , $-   , $-   ,,,Not included in contract
Cigna Health Plan,Cigna,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ", $-   , $-   ," $147,108.00 ",,,Dailey Per Diem Avg LOS 82 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ", $-   , $-   ," $21,984.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ", $-   , $-   ," $39,468.00 ",,,Dailey Per Diem Avg LOS 22 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ", $-   , $-   ," $48,438.00 ",,,Dailey Per Diem Avg LOS 27 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ", $-   , $-   ," $55,614.00 ",,,Dailey Per Diem Avg LOS 31 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ", $-   , $-   ," $21,984.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ", $-   , $-   ," $53,820.00 ",,,Dailey Per Diem Avg LOS 30 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ", $-   , $-   ," $62,790.00 ",,,Dailey Per Diem Avg LOS 35 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ", $-   , $-   ," $75,348.00 ",,,Dailey Per Diem Avg LOS 42 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,884,Organic Disturbances & Mental Retardation,,,,," $20,776.82 ", $-   , $-   , $-   ,,,Dailey Per Diem Avg LOS 9 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,885,Psychoses,,,,," $22,724.68 ", $-   , $-   , $-   ,,,Dailey Per Diem Avg LOS 11 days Pro Fees not included
Cigna Health Plan,Cigna,DRG,,Interrupted Stay,,,,, $-   , $-   , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Code Blue,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peg Tube Placement,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perfusion 1 Hour,,,,, $369.94 , $369.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Picc Line Insertion,,,,," $2,855.64 "," $2,855.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debride Skin Full,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debride Skin Partial,,,,, $351.92 , $351.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 , $652.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 , $620.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 "," $1,240.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulsed Lavage,,,,, $184.44 , $184.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wound Care,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitiamin D 600 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,0.9% 10ml Flush,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,1eppra 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,250ml Bolus Ns,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,A&d Ointment,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 "," $3,051.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 "," $3,244.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abreva Cream 2gm,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accuzyme Oint 30gm,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acebutolol 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen 500,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen 650mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen/Codeine,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetazolamide 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetazolamide 500mg,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acyclovir 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acyclovir 500mg Inj,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acyclovir Oint 5gm,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acyclovir Susp 200mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adenosine  6mg Syri,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aggrenox 25/200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albumin 25gm 100ml,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albumin 25gm Vl,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 0.083% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol Inhaler 8,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 , $745.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allegra D 24hr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allopurinol 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alosetron 1mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alphagan 0.2% Drops,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alteplase Vl 1mg,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amikacin 500mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 , $374.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 "," $1,026.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin 1gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin 2gm Inj,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 "," $1,176.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anucort-Hc 25mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aquacel  With Transparent Film,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aquaphor Oint 3oz,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 "," $2,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 , $585.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aspirin 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atenolol 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atropine 0.4mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atropine 1mg Syringe,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Augementin Xr 875mg,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aveeno Bath,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacitracin Oint,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 "," $1,595.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Beer 12oz Can,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benicar 40/12.5mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benzocaine (Oragel),,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Black Widow Antiveni Vl,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 "," $3,169.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bss Irr Soln Sol,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 , $508.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Tab : 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Captopril Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 "," $4,211.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carmex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 "," $2,205.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celestone Mdv : 6mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cetaphil Mois Lot,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 , $314.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Charcoal Liquid  25gm,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cipro 500mg Tablet,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Citrical D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 , $169.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 , $245.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 , $308.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Combigan Liquid 5ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Combivir Tablet,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Copaxone 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coumadin 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coumadin 7.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 "," $7,094.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 "," $1,566.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D10 W,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D50w 50ml Injection,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 , $452.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Danazol Cap : 200mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dapsone 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 "," $1,214.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 "," $1,057.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 "," $1,850.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 "," $1,451.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 "," $5,808.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 , $727.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 "," $1,162.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Destroxe 70% 500ml,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 10% 1000mls,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 20% 500ml,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 5% 100ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose Amp : 0.1,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 , $227.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 "," $1,568.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilacor Xr 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem 180,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dipentum Cap : 250mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 , $215.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 "," $8,438.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 "," $2,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 "," $6,604.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 "," $1,651.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 , $954.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 , $446.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 , $178.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 , $357.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ephedrine 50mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epidrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 "," $1,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 "," $1,591.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 , $921.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 , $776.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epogen 1000 Units,,,,, $904.00 , $904.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 , $614.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 "," $3,354.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 "," $1,225.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 , $512.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 "," $1,602.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythromycin 500mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 "," $1,201.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estrogens Esterified (Menest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Etodolac Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Etoposide Vl : 10mg,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 "," $1,195.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 "," $1,113.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 , $280.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrex 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flanders Butt Oin,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fleet Prep Kit #3,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 , $130.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 , $426.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 , $148.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 , $394.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 , $653.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 "," $1,015.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folic Acid 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide Xl 10mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucagon 1mg Inj,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucosamine 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Gel,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucovance 5/500,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycerin Adult Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycerin Pediatric Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycerin Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 "," $7,368.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 "," $1,020.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guiatuss Dac Syr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Halothane Liquid 250ml,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heparin Antibody,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 , $391.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 , $584.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 "," $1,681.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Icy Hot Cream Cream :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 "," $3,165.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indomethacin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 "," $3,652.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Glargine (Lantus),,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intralipids 20% 100ml,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 , $492.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 "," $1,797.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isentress 400mg Tablet,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Dinitrate,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 "," $1,273.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketamine 100mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lantus 100 Units/ML,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 "," $1,045.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levemir 100 Units/ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lice Comb Ea,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lindane Shampoo 60ml,,,,, $681.00 , $681.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 , $622.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 "," $2,385.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorcet 10/650,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorcet Plus,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 5,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 , $272.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 "," $1,213.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maalox,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magic Mouthwash,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Citrate 8oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Marinol 2.5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maxzide 50/75,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meclizine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace 400mg/10ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Melatonin 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Melatonin 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mepilex,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 , $838.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Merrem 250mg Ivpb,,,,, $690.00 , $690.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methadone 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methimazole Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metronidazole 500mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 "," $1,192.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 , $234.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miochol E Sol : 0.01,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mivacurium Inj 2mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mvp,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mysoline 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nabumetone 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nacl .9% 250ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nadolol 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naprosyn 500mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 "," $3,134.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 "," $1,073.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 "," $2,090.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 , $510.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norcuron,,,,, $886.00 , $886.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 "," $2,522.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin R 100 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolog,,,,," $2,822.00 "," $2,822.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns 1000ml Bag,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns 100ml Bag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns 250ml Adv Bag,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns 250ml Bag,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns 50ml Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns Irrigation 3000ml,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns Plus 100ml Bag,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns Plus 50ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Cream 15gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 , $449.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 "," $1,599.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 "," $1,524.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peg Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 "," $8,933.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 "," $1,999.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pentasa 250mg Capsule,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Petrolatum White Oin,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pindolol Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 , $435.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polycitra Lc Sol,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Premarin 0.625 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prenatal Vitamin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Preparation H Ointment,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Progesterone Microni (Prometri,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 "," $1,389.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protamine 50mg Amp,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 , $409.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinine 325mg Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 , $751.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 , $732.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Refresh Tears 15ml,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renagel 800mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 "," $1,694.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 , $575.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rifampin 300mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 1mg/1ml,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 , $775.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rocaltrol .25mcg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Salsalate Tab : 750mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Silver Nitrate Stick,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 "," $1,455.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 , $275.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 "," $1,622.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sorbitol 70% 30ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 , $484.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Starlix 120mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Water 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Streptomycin 1gm Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 , $288.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulindac Tab : 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulindac Tab : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Surgilube Oin : 60gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Symmetrel 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Symmetrel Syr 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 0.05mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tekturna 150mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 "," $7,624.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 , $344.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 , $685.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetracycline 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 , $560.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thrombin 5000 Unit,,,,, $937.00 , $937.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid Tab : 1grain,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 , $377.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 , $617.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin 300mg Inh,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin 80mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 , $322.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 , $419.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 "," $5,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trace Elements 5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trental 400mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 , $694.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tricor 48mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urogesic Blue Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 "," $1,023.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin 1gm Vl,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin 500mg Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vasopressin Vl : 20units,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vecuronium 10mg Inj,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil 240 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil Tab : 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vfend 200mg Tablet,,,,, $764.00 , $764.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 "," $2,499.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Viread 300mg Tablet,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vistaril 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin A 10mu Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $702.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc 10mg Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc 220mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc Oxide Ont,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $402.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 "," $1,332.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $595.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accucheck,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,A/B Otic Drops,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 15 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 30 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 5 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acarbose 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accolate 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accupril 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acidophillus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aciphex 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Actonel 35 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Actos 15 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Actos 30 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Actos 45mg,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advair,,,,, $408.00 , $408.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advair Discus 250/50,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advair Diskus Inh,,,,, $819.00 , $819.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advanced Eye Relief,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advil 200mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aerobid,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aerochamber,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aggremox Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aggrenox ER Caps,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Akwa Tears,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aldactone 25mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alendronate 35mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alendronate 70 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aleve,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Align,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allegra 180 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allegra 600 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allegra-D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Altace 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Altace 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amaryl 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amaryl 4 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ambien 10mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ambien 5mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ambilify 10 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amblify 15 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlopidine-Benaz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anafranil 25 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Analgestic Creme Rub,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anaspaz Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antacid Susp Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antioxidant Vitamins,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anusol Hc Supp,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arimidex 1 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Asacol 400 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ascensia Elite #50,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Asmanex Twisthaler,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aspercreme 10%,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Asprin 81mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atacand 16 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atacand 32 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atarex 25mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atenolol 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atenolol 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ativan 1mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ativan 2mg/ML,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atrovent Inhalation,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atrovent Inhaler,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avandia 2mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avandia 4mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avapro 150mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avelox 400mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azo Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,B-1,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Baclofen 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bactrim Ds,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $401.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benadryl 25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benadryl 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benicar 20mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benicar 40 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benicar 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztrop 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztropine 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betapace 80 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bethameth Driprop .5,,,,, $499.00 , $499.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bethanechol 50mg,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biaxin 500 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisacodyl 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biscolax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisoprolol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Black Cohosh,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blistex Lip Medex,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Boniva Tab 150,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Boost,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bumex 1mg,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspar 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspar 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspirone 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspirone 15 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspirone 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspirone 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bystolic 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calan 120 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calan Sr 180mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium 600+d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Carbonate 60,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Caltrate 600 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Campral 333 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Capoten 25mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Captopril 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Captoril 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazepine 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazepine 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardina 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardura 2 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cecon Bottle,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftin 250mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celebrex 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celebrex 200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celexa 20 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cellcept 250mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Centrum Silver Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Century 50 Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Century Senior Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cepacol Lozenges,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlestyramine Packet,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chloraseptic Spray,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorex-A Tablets,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorophyll 3mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorpromazine HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholestyramine Packs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Citalopram 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Citalopram 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Citalopram 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clarinex 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Claritin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cleocin 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clobenzaprine HCL,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine .2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrim Antifungal,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clozaril 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cogentin 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cogentin1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Col-Benemid,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Combigan Eye Drops,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Compazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Compound Rx 30gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Comtan 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Copaxone 20mg,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cordarone 200mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Corgard 40mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Corge 12.5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Corona Ointment,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Correc Cr 40mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cosopt Eye Drops,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coumadin 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cozaar 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cozaar 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cozaar 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crestor 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cymbalta 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cymbalta 30mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytra K 5ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darvocet N 100mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darvon 65mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depo Provera,,,,, $729.00 , $729.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desipramine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desyrel 100mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Detrol La 4 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diabeta 5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diclofenac Sod,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diflucan 150 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin 250mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin 50mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem ER 120,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan 160 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphedryl Sod,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divan 40mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Docusate Calcium,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Donnatel/Maalox,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxazosin Mesylate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxycycline 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dss 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dss W/Casan,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dulcolax,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duoneb 2.5,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dyazide,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dynapen 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dytan 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Effexor Xr 150mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Effient 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elavil 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $235.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elnorm 6mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril Maleate,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 "," $1,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Esidrix 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eskalith Cr,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estazolam 1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estropipate 0.625,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Etodolac 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,E-Vista 60 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Evoxac 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exelon 3mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exelon 6 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exforge 5 320mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eye Stream 30ml,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Famotidine 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Felodipine ER 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Femera 25mg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feosol,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fergon,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fexofenadine HCL,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fiber Laxative 625,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fiber Powder,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fibercon 500mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fibercon 625 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Finasteride 5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fioricet 1 Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flagyl 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flonase Nasal Spray,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $230.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flu Vaccine,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fludrocortisone Ace,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoprazine 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flurazepam,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluticasone 50mcg,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluzone,,,,, $237.00 , $237.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folamin Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foltx Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fortical Nasal Spray,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fosamax 70 Mg,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fosinopril/Hctz,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabitril 12mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Genasyme 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Genebs 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Genteal Drops,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 20 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $654.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 80 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geritol Complete,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucophage 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucotrol 5mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucovance 2.5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycolax 255 Gram,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glynase 3mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guanfucine 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 5 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 5mg/ML,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol ML 120,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hcts 1% 30gm,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humalog Ins Inj,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humulin 70/30,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrea 500 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hypotears Eye Drops,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hytrin,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,I Caps Plus,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Imdur 30 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immitrex 50 Mg,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immodium 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inderal 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inderal 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inderal La 120 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inspra 25 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Humulin R,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Invega 3 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isopto Tears,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isordil 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Nacl,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Januvia 50 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Jevity 1.5,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Juven,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K Dur 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keflex 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keflex 500mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kenalog,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $461.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keppra 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Klonopin 1 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Konsyl Powder,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Labetalol HCL,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactaid Fast Act,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamictal 100mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamictal 150mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamictal 25mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lantus Insulin 100,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lantus Insulin Inj,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Latuda 40 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Laxative Suppository,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lecithin 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lescol 20 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lescol Xl 80mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levaquin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levaquin 500mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levemir Vl,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothroid .05 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothroid 0.125,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothroid 75mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroid 25mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levthyroxine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lexapro 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lexapro 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Limbrel 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lioresal 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipitor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipitor 20 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipitor 40mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lodine 500 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lofibra,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lomox Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loniten 2.5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loperamide Hci Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lopid 600 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lopressor 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loratadine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab-5,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotensin 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovastatin 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovaza 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovenox 40mg,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loxitane 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lumigan Eye Drops,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lunesta 1 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lunesta 2 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lunesta 3 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lyrica 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lyrica 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lyrica 300 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maalox 0,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Macrobid 100mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mag Ox 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Citrate,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Oxide 241,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mavik 1 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maxzide 75/50,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medrol Dose Pak,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Susp. 5ml,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mephyton 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metaformin 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metamucil Pkt,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin 1000 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin 850 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin HCL 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methadone HCL 10mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methotrexate 25mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoclopramide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoclopramide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metolazone 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Succ,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mevacor 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miacalin 200u Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mi-Acid Gas,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Micardis 40 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Migrazone Capsules,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Minocin 100mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miralax Packet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miralex 255 Gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Moban 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Moban 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Monopril 20mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Motrin 120ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Motrin 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Motrin Susp 5ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucinex 600 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multigen Plus Caplet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multivitamin With Mineral,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Murine Tears Plus,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mylicon 80,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nadolol 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Namenda 10mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Namenda 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naphcon-A 5ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen 250 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen 500 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen Sod,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasacort Aq,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasal Solutions,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $557.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nature Tear Drops,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Navane 5 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nb Valerian Root,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neosporin Ung Pk,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neurontin 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neurontin 300 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nexium 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nexium 40 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Niacin 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nifedipine 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Niferex 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nilandon 150 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroquick,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norco 10/325 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norpramin 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norvasac 5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norvasc 10mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin 70/30,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin R 100 Units,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolog Mix 70/30,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Occuvite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Omacor 1 Gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Omnicef 300mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,One A Day,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,One-A-Day Mens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Opana ER 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orajel,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orap 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Os Cal 500d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Osteo Bi Flex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxytrol Patch,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oyster Shell Calcium,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pancrease Ec Caps,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil 20 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil Cr 12.5,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pepcid  Complete,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Periactin 4 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peridex 473ml Sol,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perparation-H Ointment,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perphenazine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan Supp,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytek 300mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pindolol 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plaquenil 200mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plavix 75mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pletac 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pletal 100mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potass Cl Meq,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravachol 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravachol 20 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravachol 40 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Precose 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisolone Acetate,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prelone 5mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Premarin Vag Cream,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Preservision Softgel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prevacid 15mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prevacid 30mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prevastatin Sod,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prisolec Otc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pristiq 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 "," $1,002.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 "," $1,815.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine Supp,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proscar 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prostate Formula,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protocream Hc 30gm,,,,, $440.00 , $440.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protonix 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protonix 40mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Provera 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Provigil 200 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prozac 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prozac 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyridoxine 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Questran Pckt 9g,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinapril 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinapril 20mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinapril 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinidine 200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ramipril 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rampipril 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranexa 500 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rapamune 1 Mg,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Razadyne 12 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Razadyne 8 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Refresh Eye Drops,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Relafen 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Remeron 15 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Remeron 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Remifemin Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reminyl 12mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip .25 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip 1mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Restoril 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rezadyne 4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rhinocort Agua,,,,, $378.00 , $378.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $932.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 1mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 2 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 4 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $946.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperidone .25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperidone .5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperidone 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperidone 4 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ritalan 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Robitussin 5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Robitussin Dm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole .25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole HCL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rozerem 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Saphris 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Saphris 5 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senna Gen Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senna Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sennalax-S Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senokot 187mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Septra Ds,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Serevent Disl Inh,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroguel 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 300 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Serzone 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shopax 100 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinemet 25/100,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinemet 25/250,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Singulair 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skelaxin 800mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slow Fe 160mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slow K-8 Meq,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sonata 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sonata 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spiriva 18mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spiriva Handihaler,,,,, $429.00 , $429.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spiriva Refill,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $660.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ssystane Eye Drops,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ST John's Wart,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Starttera 40 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stool Softner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Strattera 25 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stress W/Zinc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sumatriptan Succ,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Super Thera Vite Mt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Symbicort 80 4.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Symbyax 6/25mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Symmetrel 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid .05 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid .2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tamoxifen 10mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tapazole 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tarka 2/240,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tears Pure,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegretol 200mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tekurna 150 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Temazepam 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Temazepam 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tenex 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tenormin 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tenormin 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terazosin,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terazosin 5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terbinafine HCL 250,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theo-24 200 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theo-Dur 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theophylline 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theragran M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Therapeutic M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thermotab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiamin 50 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiamine 100 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid 2 Gr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tofranil 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tofranil 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topamax 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topiramate 100 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toprol Xl,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Torsemide 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Torsemide 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Traqzadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazadone 150 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tricor 145mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trileptal 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trilipix 45 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trimpex 100 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tums 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tussin Cough 8oz,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uloric 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ultracet 37.5/325,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ultram 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uniphyl 400mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Univasc 15mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urecholine 25mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uroxatral 10mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vantin 200 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vasotec 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vasotec 5mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil 180 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vesicare 5mg,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Viactiv Chew Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vicon C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vigamox Drops,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Visken 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin A,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B-1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D 400 U,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Volaren 1% Gel,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Voltaren 75mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Water 45 M,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Welchol 625 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Women's One A Day,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xarelto 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Z0cor 20mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zanaflex 4mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zantac 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zelform 6 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zestril 10 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zestril 20mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zestril 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zetia 10 Mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ziac 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc 50mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc Gluconate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zithromax 250 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zocor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zocor 40mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zocor 80 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zofran 4mg Tab,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zoloft 100 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zoloft 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zoloft 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zolpidem Tartrate,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zonegran 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zonisamide 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zovirax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyloprim 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyloprim 300mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 15mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexia 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyrtec 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 2 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acamprosate Calc 333,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accupril 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accupril 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accupril 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accuzyme Oint,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $559.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $632.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adderall 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adderall 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advair Diskus 100/50,,,,," $1,128.00 "," $1,128.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advair Diskus 500/50,,,,," $1,855.00 "," $1,855.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advair Hfa 115/21,,,,," $1,391.00 "," $1,391.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advil Congest Rel,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Advil Pm,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Afrin  .05 Spr,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alaway Eye Drops,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 2mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol Inhaler,,,,, $293.00 , $293.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aldactone 50 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alendronate 35 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aleve 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allegra 60 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allopurinol 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $460.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Altace 1.25 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Altace 10 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amaryl 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $613.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amikacin 500 Inj,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlactin Lotion,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amloride 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin 500mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anikacin Inj 250,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apresoline 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 "," $1,656.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arava 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aripiprazole 15mg,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Armour 90 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aromasine 25 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Artificial Tears,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $742.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aspercreme,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Astelin Nasal Spray,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atacand 8g,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atenolol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ativan 0.5 Im,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 "," $1,242.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $711.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Augmentin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avandia 8 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $733.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ayr Nasal Mist,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azilect 1 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azmacort,,,,, $607.00 , $607.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azopt Drp 1%,,,,, $482.00 , $482.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Azor 5/40 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacid Capsules,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Baclofen 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Baclofen 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Baclofen 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacmin Tab 1,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $680.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bee Pollen,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benadryl Crm 2%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benicar 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benztropine 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betamethasone Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betoptic S Ophth,,,,, $480.00 , $480.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 "," $1,129.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biotene Mouthwash,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisacodyl 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brimonidine 0.2%,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brintellix 10 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 "," $1,086.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bystolic 10 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bystolic 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calan 80 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcarb 600 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitrate 600 + D,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Carb 600mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calmoseptine Pks,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Caltrate 600 Plus,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardizem 30 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardizem 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardura 1 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardura 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carmex Lip Ointment,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Casodex 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefpodoxine 200,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftin 500 Mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cefzil 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celestone 2 ML Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celexa 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celexa 15 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celexa 40 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cellurisc 1%,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Century Senior Vitamin,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Century Vite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cepacol Throat Spray,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cephalexin Monohydra,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cerefolin,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cerefolin Nac,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cetaphil 80z,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chantix .5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chantix 1 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholestyramine Powder,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chromagen Forte,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chromium 200 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $683.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Citracal Petites,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Citrucel Each Scoop,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clarithromycin 500mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Claritin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin Oint,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $385.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine 0.1,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $447.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $349.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole 1%,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clozapine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clozaril 100 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clozaril 50 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clozipine 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clozipine 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cogentin 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colace 100mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colace 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colcrys .6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colon Clenz Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $621.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Combivent Respimat Inh,,,,," $1,335.00 "," $1,335.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Complex + Msm,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coq-10 200 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coreg 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coreg 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coreg 40 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cortef 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $436.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coumadin 6 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Creon Dr 3000 U,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crestor 20 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crestor 40 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crestor 5 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytomel 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dantrolene Sodium,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Decadron 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Delsym Each Tsp,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote 1000 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote 1500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote 750 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Deplin 15 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desipramine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desloratadine 5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Desonide Lot 0.05,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexilant 30 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dexilant 60 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dextrose 50% Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diamox 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diary Digest,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diatx Tab 1,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diflucan 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diflucan 200 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin 0.1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin 0.25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $243.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin 200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin 400 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan 320 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diovan 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ditropan 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ditropan 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Docusate Calcium 240,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $121.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin 75 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duleek Met,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dulera Inhaler,,,,," $1,241.00 "," $1,241.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duoneb 3ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ear Wax Drps,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Effexor 225 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Effexor 50 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elavil 100 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $506.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elimite Cream 5%,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eliquis 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elmiron 100,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enablex 15mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril Maleate 10,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enoxaparin 100mg,,,,, $583.00 , $583.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Entacapone 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Entacort .25 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epoetin Alfa,,,,," $4,247.00 "," $4,247.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estroven Weight Mgt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Etodolac 100mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Etodolac 400 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ex-Lax,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fanapt 1 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fanapt 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fanapt 4 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Felcainide 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feldene 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Felodipine 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fenofibrate 145mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feogen Ga,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fergon 27 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fergon 324 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flagyl 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flecainide 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flector 1.3% Patch,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flexeril 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flexeril 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Florajen Acidophilus,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Floranex Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Florastor 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flovent Hfa,,,,," $1,507.00 "," $1,507.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $625.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folacin B/6/B12,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folbee Vitiamn,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folbic,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foltanx 90 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foltrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $284.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Freshkote Eye Drps,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Furosemide 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fycompa 8 Mg,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabitril 16 Mg,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabitril 6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabitril 8 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gas X 180 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gaviscon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 10 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 10mg Injection,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 30 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glcagon Inj,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide 15 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glipizide 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucophage 250 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Tablets,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide 3 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gs Century Vits,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $58.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gynalotrimin,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hematogen Capsule,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemocyte Plus,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hum Benzoin Compound,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocort 2.5%,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $684.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,I Car-C Plus Sr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,I Vite,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Icaps M/V (Eye),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Imdur 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Imipramine 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inderal 25 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indocin 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indomethacin 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insta Glucose Gel,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Instaflex Joint Support,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Integra Vit,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 "," $2,076.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Invokana 100 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Jantoven 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Januvia 100 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Januvia 25 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,J-Tan D Sr,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K Clor 8 Meq,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K Dur 20 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K Dur 30 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K Dur 40 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K Phos,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 10 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kcl 8 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keppra 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keppra 750 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Klonopin 2 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Klor Con 10 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Klor Con 20 Meq,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Labetalol 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Labetalol 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lacrilube Oint,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactaid,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactinex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactulose 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamictal 200 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $171.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamisil,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamisil 250 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamotrigine 25mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lanacane Compound Oint,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Latuda 20 Mg,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Latuda 80 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $972.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levaquin 750 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levemir Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levemir Flexpen,,,,," $1,510.00 "," $1,510.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothroid .15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothryoxine 88mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lexapro 15 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lexapro 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lexapro 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Librium 5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipitor 80 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium Carbonate 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Livalo 2 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lodrane D24,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loperamide 2 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lopressor 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lopressor 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 2.5/500,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Losartan 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Losartan 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Losartan 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotemax Opth 5%,,,,, $657.00 , $657.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotensin 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotensin 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotensin 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loteprednol Drop,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovaza Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loxapine 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loxapine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $692.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lyrica 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lyrica 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lyrica 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maalox 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medical Food 1 Tab,,,,, $188.00 , $188.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace 60 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 "," $3,406.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megestrol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Melatonin .75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Melatonin 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Memantine HCL 10mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mestinon 60mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metafolbic Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metalozone 5 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metamucil Cap,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metanx 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin 250 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin 600mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methadone 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methadone 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metronidazole 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 "," $1,011.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Micardis 80 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midodrine 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Midrin Capsules,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Minipress 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Minocycline 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirapex 1 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mobic 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Modafinil 200 Mg,,,,, $47.00 , $47.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Monopril 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Montelukast 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine 15 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucinex D,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multaq 400 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multivitimine,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mylanta 15ml,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mylanta 30 Cc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mylanta Bottle,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mylicon 125 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nalfon 400 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naprelan 375 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen 375 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen 550 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Narco 10/325,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Narco 5/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasal Crom Spray,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nauzene,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neosporin,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neurontin 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neurontin 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neurontin 800mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neurontin 900 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neutro Phos 250mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Niacin 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine Transdermal,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nisoldipine 20mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitrolingual Spray,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norco 5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norflex 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin 100units,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolog Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Novolog Flexpen,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuedexta 20/10,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $319.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ocean Mist,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ocean Nasal Spray,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ointment 120 Com,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 5mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Omeprazole 10mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Onfi 10 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Onglyza 5 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Opcon A Eye Drops,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Optive Eye Drops,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Os Cal 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Osphena 60 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone 5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paceron 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paceron 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pamelor 50 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pamelor 75 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pancrelipase 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pangestyme Ec,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pataday Eye Drops,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Patanase Nasal Spray,,,,, $535.00 , $535.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Patanol,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $774.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paxil 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pentazocine Nalox,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pepcid 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pepcid 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Percocet 3.75/250,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Percocet 5/325,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peri Colace,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Periactin 2 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phazyme 180 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenergan W Codine,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital 60mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phentermine 37.5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pioglitazone 30mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pioglitazone 45mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plagic 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plavix 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plendil 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plendil 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ployethylene Glycol,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pneumonia Vaccine,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Ch 10meq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Phos 250,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prandin 1 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravachol 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prazosin 1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prazosin 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prazosin 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 30 ML,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prednisone 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pregabalin 25mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pregabalin 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Premarin .9 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Premarin 0.3,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Premarin Cream 30g,,,,, $978.00 , $978.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Preparation H Supposority Box,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Preservision Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prevalite Powder,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prilosec 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Primidone 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Primidone 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pristiq 100 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proamatine 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proamatine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Probenecid Colchicicine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 "," $1,277.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $725.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $274.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prograf 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prometrium 100 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promod 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol 80 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prosight,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prostat 30 Cc,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Provera 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Provigil 100 Mg,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prozac 40 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $432.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prozosin 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Psyllium See Pack,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $656.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulmocare Nutrition,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyridium 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Qnasl Nas Spray,,,,, $700.00 , $700.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Questran 2 Gm,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Questran 9gm Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinidex 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Qvar Inhal,,,,, $825.00 , $825.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ramipril 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Refresh Pm Ointment,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 "," $4,243.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Remeron 45 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renvela 800 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip .125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip 0.5mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip 4 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Resperdol 1 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Restasis 0.5%,,,,, $815.00 , $815.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Restoril 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rifampin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risamine Oint,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $257.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal 6 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $766.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 "," $1,716.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 "," $2,250.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 "," $3,147.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperidone 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Risperidone 3 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ritalin 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ritalin 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ritalin 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rivastigmine 3mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Robaxin 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Saline Flush,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sam E 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sam E 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sanctura 20mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Santyl Top,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Savella 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Selenium Shampoo,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senna 8.6mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sensipar 30 Mg,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Serax 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 500 Mg,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel 75 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sertraline 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sertraline 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Silenor 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Silvadene Cream,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Silversulfadiazine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simethicone 80 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinemet 12.5/50,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinex Nose Spray,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Singulair 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sotalol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sotalol 80mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spiriva Inhaler,,,,, $444.00 , $444.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sporanox 100 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sps Suspension 60ml,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stalevo 100 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stalevo 150 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stalevo 50 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stalevo 75 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Starlix 60 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stelazine 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stelazine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $134.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sudafed 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sudafed 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sular 17 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sular 34 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sumatriptan 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sumatriptan 25mg,,,,, $427.00 , $427.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Surmontil 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 "," $1,384.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 "," $1,029.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tagamet 400 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tamiflu,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tapazole 10 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tapazole 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tarvatan Drops,,,,, $514.00 , $514.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tavist,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegretol 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegretol 300 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegretol 400 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tekturna 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tenex 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terazosin 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theophylline 400 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theraseal Hand Cream,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tiagabine 4mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ticlid 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tigan 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tinactin Spray,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobradex Eye Oint,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobradex Opth Drops,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $451.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topamax 200 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topamax 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topiramate  25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topiramate 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toradol 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toviaz 8 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trandate 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Travoprost Eye Drops,,,,, $538.00 , $538.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone 25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tricor 48 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trilafon 8 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trileptal 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trileptal 400 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trileptal 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trileptal 75 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trilipix 135 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trospium 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tums 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tums 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tums 650 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Turmeric Curcumin,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol 325 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol 650 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol Pm,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ultracet 100,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urecholine 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urelle Tablet,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uricholine 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urimar-T Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ursodiol 300mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valisone,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valium 5 Mg Im,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid 125mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid 500mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valsartan 160,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valsartan 320 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valsartan 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valtrex 500 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $238.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil 80 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vesicare 10mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Viamin B Complex Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Viamint E 200iud,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Victoza Epipen,,,,, $821.00 , $821.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Victoza Pen Bx,,,,," $2,143.00 "," $2,143.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Viibryd 40 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vimpat 100 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vimpat 200 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vimpat 50 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Visine Eye Drops,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vistaril 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B3 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Vitamin D 50,000",,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vivactil 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vivactil 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Voltaren 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Whey Protein Isolate,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xarelto 15 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xarelto 20 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $276.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xopenex Inhaler,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Z-Gen,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zioptan Eye Drops,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zithromax 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zocor 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zofran 8 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zoloft 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zoloft 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zolpidem Cr 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $982.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zpak 250 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyrtec 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zyvox 600 Mg,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Torsemide 5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Candesartan 8 MG,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orap 1 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $197.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Norvasc 5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CEROVITE SR TABS,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BUPROPION 75 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,venlafaxine 25 mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 "," $1,474.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VYVANSE 50 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $362.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $631.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 "," $1,062.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 "," $1,405.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $3.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $728.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ULORIC 80 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CREON 12000 U,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BRILINTA 90 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FUSION PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FOLBEE PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 "," $1,194.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LINZESS 145 MCG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LATUDA 60 MG,,,,, $144.00 , $144.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,INVOKANA 300 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VIMPAT 150 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DILANTIN 30 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PREPARATION H SUPP,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,REXULTI 1 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FARXIGA 10 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,REXULTI 2 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MELATONIN 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $816.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FETZIMA 40 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FETZIMA 80 MG,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NAPCON A SOL,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MELATONIN 0.5,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $787.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LIVALO 4 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 "," $1,538.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $193.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 "," $1,766.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $199.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FE C TAB 100,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mybetriq 25 mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $1.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $2.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $79.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AZOR 10/40 MG,,,,, $49.76 , $49.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LABETALOL 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 "," $2,517.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CREON 6000 U,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,REXULTI 3 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $20.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 "," $1,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $3.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $3.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $52.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $6.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $34.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $68.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ATRIPLA,,,,, $399.80 , $399.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $13.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $1.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $1.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $3.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $59.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $818.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $61.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $1.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $4.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $131.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $51.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $3.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $445.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $2.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arginaid Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $525.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 "," $1,992.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coban,,,,, $10.32 , $10.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Descovy 200 25 mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $291.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estroven 1 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lamicatal 200 mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lisinopril 15 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $51.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $33.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $7.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metoprolol 100 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $165.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebivolol 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pataday 2% (bottle),,,,, $594.00 , $594.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pataday 2% (drop),,,,, $19.80 , $19.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $3.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $11.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Primidone 150mg,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Propranolol 20mg,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Requip 3mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Salagen 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tivicay 50 mg,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toprol 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Torsemide 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tresiba (unit),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Warfarin 40mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zocor 20mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zocor 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zoloft 200mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zonisamide 75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Naproxen 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinemet 50/200mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $63.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $3.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $540.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tandem Plus Capsule,,,,, $6.96 , $6.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $28.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $2.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LATUDA 10 MG,,,,, $99.91 , $99.91 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MULTILEX,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $202.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $195.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $13.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $7.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $31.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $26.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $9.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $188.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $1.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LINZESS 290 MCG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $2.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $113.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $2.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $37.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $21.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $5.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $14.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $257.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $56.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $55.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $23.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $43.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $17.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 "," $1,548.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pentasa 500 MG,,,,, $29.32 , $29.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CENTRATEX,,,,, $4.48 , $4.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $11.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $5.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $9.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $55.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,REXULTI 4 MG,,,,, $184.68 , $184.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $8.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $148.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $2.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $58.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $8.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $6.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $172.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,SALSALATE 500MG,,,,, $71.22 , $71.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $100.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $34.17 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $48.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $81.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $15.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuplazid 34 mg,,,,, $304.74 , $304.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 "," $1,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $8.29 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $122.61 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Infusion Therapy,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 "," $2,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $421.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $844.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $231.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,10ml Control Syringe,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,14fr Stylet Slip,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,21 Lnr Ps,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $189.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,300cc Collection Canister,,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,48  Press Moniter Line,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adapter T,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Air Hose Disposable,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Air Hose Reusable,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alcohol Prep Pads,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Algidex Ag Gauze,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Reflux Filter,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antifungal Cream,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antireflux Filter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bacteria Filter,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Scissors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $38.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Surepress Compression,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Barrier Film,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bed Air 48,,,,, $119.78 , $119.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bed Air 48  Turning,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betadine Sol 8oz,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Betadine Swabsticks,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bite Block,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $359.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bottle 100ml Saline,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bp Cuffs Medium,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bracket  Mounting,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Bridge,suture Retention",,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brief Adult Large,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bucks Traction Boot,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calazime With Olivamine,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cannula Etc02,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Cap, Trach",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carafe With Straw,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $57.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter Connector,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter Connector (Blue),,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter IV,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter Stabilization Device,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Centerpointlock Pouch,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 "," $1,068.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Tube Tray,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Clamp, Beta",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Clamp, Occluding",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Cold Pack, Instant",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $27.15 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Commode Containers,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cone Finger Separater,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cooling Blanket,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Cover, Probe",,,,, $76.32 , $76.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $259.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cup Medicine,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debridement Tray Gss,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Del Clamp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digital Termometer,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dispo-A-Probe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Disposable Headstrap,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Disposable Lead Wires,,,,, $261.82 , $261.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drain Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $58.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dycem Matting,,,,," $1,064.24 "," $1,064.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Edema Gloves 1ea,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Expiratory Filter,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 "," $2,764.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flexiseal Bag,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flexiseal Management System,,,,," $2,640.46 "," $2,640.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $10.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Forceps, Adson",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Full Face Mask Large,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Full Face Mask Medium,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Full Face Mask Small,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gair Built Blue,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $323.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Geri Chair Cushion,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gloves Large Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gloves Medium Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucerna 1.2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hair Brush,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Pitt Padded,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemostat Absorbable,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,High Flow Humidification Syste,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hip Kit,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hot Packs,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrogen Peroxide,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $135.21 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ioban Steri Drape,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Start Kit,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kerlix Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kit Suture Removal,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $157.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $220.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 "," $1,022.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee Support Brace,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Label IV Day of Week,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $97.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Large Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liquid Skin Protectant,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lotion Hand/Body,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $103.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Male External Cath-Medline,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask, Ear Loop",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask, Full Face Large",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask, Full Face Small",,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask, Nasal Small",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Med Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meplix Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Odor Eliminator Scented,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oral Care Kit,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Pack, Basic",,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Palm Cups 60mm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Palm Grip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Passy Muir Valve,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Petroleum Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pneumothorax Set,,,,," $1,244.44 "," $1,244.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Port Protector,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $118.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 "," $1,866.07 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 "," $2,014.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pressure Port for Therapep,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $101.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Razors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reacher 32,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ready-Bath,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rectal Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $596.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Set Catheter Irrigation,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoe Horn Long 24,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoulder Immobilizer,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shower Caps,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skin Closure Strips,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $42.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Soap Deodorant,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Speicmen Collection Commode,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spenco Boot--Outer,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Saline 100ml,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Sheets,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Water 1000ml,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suction Canister 1200cc,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suction Canister 2400ml,,,,, $34.98 , $34.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 "," $1,417.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suture Removal Kit,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 20cc Ll,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Syringe, Insulin",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tape Durapore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tape Measure,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tape Micropore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tape Transpore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tape Transpore 2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $186.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theraband Green,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Therapep,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theraputty Red,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theraputty Yellow,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thick & Easy,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thigh Garment Scd,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tongue Blade,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trac Y Connector,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $44.37 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Tray, Percutaneous",,,,, $629.64 , $629.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tubing Corrugated,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $18.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinal Female Guardian,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinal Male Supreme,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vac Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vent Circuit,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vest Starter Kit,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Viscopaste Pb7,,,,, $109.18 , $109.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitalstim Therapy,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Water Pitcher 22oz,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wedgesx2,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Weighted Bendable Fork,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wing Infusion 22inch,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Winged Infusion 20in,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $239.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adult Wipes,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alcohol Preps,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alldress Dressing,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Catheter,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arm Sling,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Baby Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandaid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Briefs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Comb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Connecting Tube,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Denture Adhesive,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Denture Cup,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Deodorant,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dressing Change Charge,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duoderm Dressing,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,E Cylinders,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enema Bag With Soap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ensure,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Extension Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feeding Set,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fleets Enema,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucerna,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Strip,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Graduated Container,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gt Bag,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hair and Body Shampoo,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heel Protectors,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hibiclens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Hose, Care Knee",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Introcan 22g 1 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kerlix,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kleenex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lancet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lice Treatment,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lip Balm,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Messengile Douche,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mouthwash,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nail File,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasal Cannula,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebulizer,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,No Rinse Shampoo,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,O2 Concentrator,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perineal Cleaner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Posie Pads,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Q-Tips,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shave Cream,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skin Prep Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Slipper Socks,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Soap Bar,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Speci-Hat,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Specimen Container (Sterile),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Staple Remover Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe With Needle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Telfa Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thick It,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toothbrush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toothette,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toothpaste,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tubing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Underpads,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinal,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vaseline,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vial Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vista Pump,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vista Pump Set,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wash Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Water Pitcher,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wound Cleaner,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wound Gel,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Emery Board,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Emesis Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,2 3/4  Wafer,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"4"" Kerlick",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"4""drainable Pouch",,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ace Bandage,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adult Pullups Large,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adult Pullups Medium,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adult Pullups Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bed Pan,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ben Gay,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Briefs Extra Large,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Briefs Large,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Briefs Medium,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Briefs Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Butterfly Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Autoguard 20,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Catheter, Condom",,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Catheter, Foley",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clean Catch Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colostomy Pouch,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Denture Brush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ensure Shake,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enteral Feeding Kit,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $822.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heel Suspension Boot,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Horizon Tubing,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hoyer Lift Pad,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydrogel Dressing,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ileostomy Bag,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Incentive Spirometer,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulated Water Carafe,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iodine Prep,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Pump Daily,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lubricating Jelly,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lubriderm,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medseptic Packet Each,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebulizer W/Mask,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nizoral Shampoo,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Non Adherent Pads,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ocean Spray,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Paper Tape,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Personal Belonging Bag,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Resource 8 Oz Can,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sarna Lotion,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Selson Blue Shampoo,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Speciman Cups,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Straight Catheter,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suplena 120 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 12cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 1cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 3cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 5cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ted Hose Knee High,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ted Hose Thigh High,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tinactin Powder,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Unna Boot 4""",,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vaseline Pkts,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wafer,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bariatric Bed,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Air Mattress,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trapeze Bar,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wound Vac,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bariatric Lift,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CATHETER MIDLINE,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Catheter, short term, straight",,,,," $2,543.00 "," $2,543.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blanket Bair Hugger,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,STERILE CAP MALE,,,,, $0.50 , $0.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 "," $2,713.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,B.D. Neelde,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Distilled Water,,,,, $11.19 , $11.19 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Steri Strips,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sling Arm Large,,,,, $28.18 , $28.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Collar Cervical,,,,, $84.62 , $84.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoe Post OP,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Boot Ankle Contracute,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Belt Gait 60inch,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Decannulation Plug,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $41.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abduction Wedge,,,,, $551.60 , $551.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Airway Guedel 70mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Airway Guedel 80mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $8.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Surgitube Large,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Surgitube Small,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $282.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee Immobilizer,,,,, $271.24 , $271.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $79.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $26.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $40.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $259.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $259.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $27.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $16.35 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Admission Set Up,,,,, $831.04 , $831.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cannula High Flow,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coloplast Clamps,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Control Mitt,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Isosource,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Jevity,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Juven,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Nepro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Oxepa,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Prostat,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $219.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trapeze Free Standing,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Central Line Dressing Kit,,,,, $822.48 , $822.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eclipse Injection Needle,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humid Vent 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aldosterone Bld,,,,, $938.10 , $938.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amitriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Huab,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Yob,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Benzodiazepines,,,,, $302.10 , $302.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamezipine Free,,,,, $237.44 , $237.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath for Collection,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPT Initial,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPT Subsequent,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiv-1,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lead Urine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Manual Differential,,,,, $623.28 , $623.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Microalbumin Urine,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myoglobin,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Parvo Virus Igg,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Parvo Virus Igm,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 "," $1,968.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $68.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protime,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $215.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Smear Nasal Eos,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sputum Collection,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinalysis Dipstick,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venipuncture,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,West Nile Virus Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,340 Measure Volume,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Afb Culture,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Afb Sensitivity,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ANA Titer & Pattern,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Scl 70,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antigen Type,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aso Titer,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bld Type Du,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Marrow Studies,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CBC With Auto Diff,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cell Count Csf,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlamydia by Probe,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlamydia Group Ab,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $549.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cmv Igm Ql,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crystal ID Synovial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Directogen Serum,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eosinphhil Count,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epstein Barr Ea,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epstein Barr Ebna,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epstein Barr Vca,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Era,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Febrile Agglut Each,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fecal Fat,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fibren Split Product,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fibrinogen Quan,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flow Cytometry Dna,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,H Pylori,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Handling Fee,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemo Influenza,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $348.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiv,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiv Viral Load,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiv Western Blot,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Holter Monitor 24hr,,,,, $414.00 , $414.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hpv Culture,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iep Except Serum,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iep Serum,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kell Ag Titer,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lupus Anticoagulant,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Manuel Diff,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metanephrines Urine,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Misc Immun Proc,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ob Screen,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Occult Blood,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ova Paras Smears,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pertussis Smears,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Cnt,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Count Auto,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pra,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein Electrophore,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rapid Group A Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rapid Group B Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Retic Absolute,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $397.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rocky Mountain Igg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,RPR,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,RPR Titer,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,RSV,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,SED Rate,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Semen Analysis Compl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Semen Post Vasectomy,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sickle Cell Prep,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Smear Review by Path,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urea Breath Collect,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinalysis,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinalysis Chem Only,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urine Immun Fixation,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urine Microscopic,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Varicella,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,WBC,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,West Nile Igm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wet Mount,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $546.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $701.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $719.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ova Parasites Ocp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $839.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urine 24 Hour,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urine Culture,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,WBC W Differential,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT/INR,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TPA tissue plasminogen,,,,, $136.12 , $136.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Acetone, Quant",,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Actaminophen,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acth,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acth Treatment,,,,, $467.46 , $467.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albumin Body Fluid,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alcohol Blood,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alcohol Urine,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aldolase,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $443.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alkaline Phosphatas,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amikacin,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amiodorone,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ammonia Blood,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amphetamine,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amylase Body Fluid,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amylase Isoenzyme,,,,, $723.98 , $723.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amylase Serum,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Androstenedione,,,,, $929.62 , $929.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antidiuretic Hormone,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antihistone Ab Quant,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apolipoprotein A,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apolipoprotein B,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arsenic Any Source,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,B Naturetic Peptide,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Barbiturates Quant,,,,, $445.20 , $445.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Basic Metabolic Panel,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bilirubin Direct,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bilirubin Total,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bupropion,,,,, $587.24 , $587.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,C Peptide,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Blood,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Ionized,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcium Urine 24,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carbon Diox Co2,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carboxyhemoglobin,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Carotene,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Catecholamines Total Urin,,,,, $710.20 , $710.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CEA,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ceruloplasmin,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chloride 24hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chloride Blood,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chloride Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholesterol Hdl,,,,, $201.40 , $201.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholesterol Total,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholinesterase Rbc,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 "," $1,577.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chromatography Quant,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Comp Metabolic Panel,,,,, $684.76 , $684.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Copper,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cortisol Am,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cortisol Pm,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cortisol Serum,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPK Isoenzymes,,,,, $412.34 , $412.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPK-Mb,,,,, $354.04 , $354.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $214.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Creatinine Clearance,,,,, $286.20 , $286.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Creatinine Serum,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Creatinine Urine Random,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cryoglobulin,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyanide,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyclosporine Level,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cystine Urine 24hr,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diazepam Assay,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Digoxin Lab,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dimeric Inhibin A,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doxepin (Sinequan),,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drug Screen Urine,,,,, $619.04 , $619.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Drug Screen:confirmation,,,,, $196.10 , $196.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D-Xylose,,,,, $526.82 , $526.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electroholresis-Serum,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electrolyte Panel,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Enzymatic Digestion,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Erythropoietin,,,,, $848.00 , $848.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estradiol Serum,,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estriol Unconjugate,,,,, $263.94 , $263.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estrogen Total,,,,, $694.30 , $694.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estrone,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fecal Fat Quant,,,,, $539.54 , $539.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fecal Fat Screen,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ferritin,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Folic Acid Rbc,,,,, $337.08 , $337.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Folic Acid, Serum",,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $607.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $474.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastrin Serum,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,General Health Panel,,,,," $1,186.14 "," $1,186.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gentamicin Level,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ggt,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucometer Lab,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose G6pd,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Random,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $64.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucsoe Blood,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Haptoglobin Quant,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemoglobin Electroph,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemoglobin Plasma,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemoglobin Urine,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemosiderin,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatic Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitus Panel,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Homocystine Serum,,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxyproline Free,,,,, $986.86 , $986.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immunoglobulin E,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $744.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immunolgobulin Igo,,,,, $677.34 , $677.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Impramine,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Total,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intrinsic Factor,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iron,,,,, $170.66 , $170.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iron Binding Capacity,,,,, $54.06 , $54.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketone Serum,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,L/S Ratio Quant,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactoferrin by Eia,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LDH Body Fluids,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LDH Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LDH Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lead Blood,,,,, $304.22 , $304.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lidocaine,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipase,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lipid Profile,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lithium Quan,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loh Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Loh Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Luteinizing Hormone,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Magnesium,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mercury,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $692.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methadone,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $728.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Microalbumin,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $603.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myoglobin Urine,,,,, $497.14 , $497.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Niacin Level,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nicotine,,,,, $243.80 , $243.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Noratriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nucleotidase 5,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Occult Blood Gastric,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Occult Blood Stool,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oligoclonal Bands,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Opiates Quantitative,,,,, $278.78 , $278.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Osmolality Blood,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Osmolality Urine,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Parathyroid Hormone,,,,, $422.94 , $422.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $409.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pcr Amplification,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ph Body Fluid,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenobarbital,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin Free,,,,, $536.36 , $536.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phosphatase Acid Total,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phosphatydylglycerol,,,,, $696.42 , $696.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Porphob Urine (Quant),,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Random Urine,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Serum,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pre Albumin,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Primidone (Mysoline),,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Procainamide,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Proclactin,,,,, $509.86 , $509.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Progesterone,,,,, $410.22 , $410.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein 24hr Urine,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein Phoresis Serum,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein Phoresis Urine,,,,, $345.56 , $345.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein Random Urine,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein S Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein Total,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PSA Total,,,,, $399.62 , $399.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pseudocholinesterase,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Quinidine Level,,,,, $358.28 , $358.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reducing Substance Stool,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renal Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Salicylate,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 "," $1,499.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sgot or AST,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sgpt or ALT,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Body Fluid,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Serum,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sodium Urine,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Specific Gravity -Other,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stone Analysis,,,,, $349.80 , $349.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stone Analysis Quan,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stone Rosk Citrate,,,,, $490.78 , $490.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stool for Reducing Substances,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,T-3 Free,,,,, $966.72 , $966.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,T-3 Resin Uptake,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,T-3 Total,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tacrolimus,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Testosterone Free,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Testosterone Total,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Theophylline Level,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thiamine Vit B1,,,,, $614.80 , $614.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroxine Free T4,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroxine Total T4,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tibc Without Iron,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tobramycin Test,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transferrin,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trazodone,,,,, $579.82 , $579.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tricyclic,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Triglycerides,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Troponin Quantitative,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Trypsinogen Serum,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tryptase Serum,,,,, $651.90 , $651.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tularemia Agglutinins,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uric Acid Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uric Acid Serum,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vancomycin Test,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vasopressin,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin A-Test,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B12,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $925.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin C Blood,,,,, $625.40 , $625.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 "," $1,055.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 "," $1,023.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin D Level,,,,," $1,085.44 "," $1,085.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vitamin E Serum,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vma Urine 24hr,,,,, $487.60 , $487.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Volatiles,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zinc Serum,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renin,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Acetylcholine Recep,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Albumin Serum,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amniostat,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti-Histone Abs,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Barbiturates Confir,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chloride Urine,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholinesterase,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Creatinine Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dhea S Serum,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Estrogen Level,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eth0suximide,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ethylene Glycol,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gloucose Body Fluid,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose 5 Hr,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glucose Whole Blood,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiaa Urine,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Iron Serum,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,L/S Ratio,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lactic Acid,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,LDH,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ldl Measured,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liver Profile,,,,, $521.00 , $521.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Methylmalonic Acid,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Misc Chem/Tox,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Osullivan,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Phosphorus Serum,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Potassium Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PSA Free,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Topiramate Quant,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Uric Acid Urine,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vma Urine,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Keppra Serum,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ketosteriods,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liver Function Test Lft,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ab Encephalitis California,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Adenovirus Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $175.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $498.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Aspergillus,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Blastomycosis,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Brucella,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Coccidioides,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Dna,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Elution,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $592.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Leptospira,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Rpn,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Sjogren,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antiphospholipid,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aso Screen,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bartonella Antibody,,,,, $662.50 , $662.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bences Jones Protein,,,,, $449.44 , $449.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blood Typing Rh (0),,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blood Typing Rh (D),,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bordetella Pertussis,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brucella Obortus,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,C Reactive Protein,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,C1 Esterase,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ca 125,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ca 15-3,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ca 19-9,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ca 27-29,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Calcitonin,,,,, $390.08 , $390.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cardiolipin Antibody,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Celiac Disease Antibod,,,,," $1,424.64 "," $1,424.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cell Total Count,,,,, $636.00 , $636.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlamydia Antibody,,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cie,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clotest/Culture Urine,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Complement Antigen,,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Complement C1 Function,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Complement C3 Antigen,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Complement C4 Antigen,,,,, $89.04 , $89.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Complement Total (Ch 50),,,,, $597.84 , $597.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crp Ultrasensitive,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cryptococcal Antigen,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytomegald Igg,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Direct Coombs,,,,, $137.80 , $137.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dna Antibody Single,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Du Typing Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ehrlichia Titer,,,,, $217.30 , $217.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Encephalitis East Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Encephalitis ST Louis,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epstein Barr (Ea),,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feb Agglut Ea,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feb Agglut Papa A,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feb Agglut Typh D,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Feb Agglut Typh H,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Frozen Blood Preparation,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fta-Abs,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $342.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $356.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis C Antibody,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis C Riba,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Herpes Simplex Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Herpes Simplex Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heterophile Abititer,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hla Typing B27,,,,, $649.78 , $649.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immundelectrophoresis,,,,, $363.58 , $363.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $546.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Islet Cell Antibody,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Legionella Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $310.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lyme Disease Antibody,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mhatp,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mitochondrial Antibody,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mono Test,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mumps Antibody,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Antibody,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pneumococcal Abs,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pooz Echinococcus,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Processing Autologous,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ra Titer,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rh Phenotyping,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $508.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rotavirus,,,,, $569.22 , $569.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rubella Igg,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rubella Specific Igm,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rubella Titer,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scheroderma Antibody,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $463.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 "," $1,043.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroglobulin Antib,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toxoplasma Igm,,,,, $405.98 , $405.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Varicella Igg,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Varicella Igm,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rubeola Titer,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vorl-Csf,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody ID,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Screen,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crossmatch is,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antithrombin Iii As,,,,, $771.68 , $771.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apc Resistance,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aptt,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Automated Platelet Count,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bleeding Time,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CBC Complete Automated,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coagulation Time Activ,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D Dimer,,,,, $517.28 , $517.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,D-Dimer Quantitative,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eosinophil Count,,,,, $181.26 , $181.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor 8 Level,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 "," $1,073.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor Ix Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor V Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor X Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor Xi Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor Xii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Factor Xiii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fibrinogen Activity,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hematocrit,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hematocrit Spun,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemoglobin,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $332.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kleihauer-Betke,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Morphology,,,,, $520.46 , $520.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Aggregation,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Countaiuid,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Countimanual,,,,, $146.28 , $146.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Function Assay #1,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Platelet Neutralization,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein C Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Protein S Total,,,,, $855.42 , $855.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PTT Practionated,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rbc Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reticulocyte Count,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $435.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sedrate-Westergren,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,WBC Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wnc Diff Only,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Af N Men A/Y,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Afb ID Direct Probe,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aft Smear Only,,,,, $193.98 , $193.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ag N Men C/U,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clostridium Diff Tox,,,,, $712.32 , $712.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Anaerobic,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Blood,,,,, $84.80 , $84.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Body Fluid,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Cath Tip,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Chlamydia,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Csf,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Fungus (Blood),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Fungus (Skin),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Gc Definitive,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Genital,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $311.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Herpes Typing,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Non Urine ID,,,,, $81.62 , $81.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Sputum,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Stool Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Throat,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Throat or Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Urine,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Urine ID,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Viral,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Culture Wound Aerobic,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fungus Smear,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gram Stain,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $251.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $575.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis C Quant,,,,, $250.16 , $250.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $922.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Herpes Virus Isol,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Histoplasma Antigen,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $395.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $702.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,India Ink Prep,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Influenza B by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Jc Virus by Pcr,,,,," $1,089.68 "," $1,089.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Koh Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Legionella Antigen Urine,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Malaria Smear,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $884.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neutrophil Ab,,,,, $267.12 , $267.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ova and Parasites,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pinworm Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Refacid Fast Culture,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,RSV Rapid Test,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sensitivity Mic,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Strep Group A Antigen,,,,, $206.70 , $206.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,West Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cult Fungi Other,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cult Grp B Strep,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bile Urine,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bile Urine Auto,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reducing Substance Urine,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Timed Volume Measurement,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinalysis Macro Only,,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urinalysis Micro Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Indirect Coombs,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 "," $2,905.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $230.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clinical Consult Limited,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $149.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flow Cytometry,,,,, $577.70 , $577.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fna Evaluation,,,,, $204.58 , $204.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $532.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cytology Cell Block,,,,, $281.96 , $281.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Decalcification Procedure,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $638.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pathology Consult In Surg,,,,, $815.14 , $815.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pathology Level I,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pathology Level Ii,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pathology Level Iii,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pathology Level IV,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pathology Level V,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pathology Level Vi,,,,, $617.98 , $617.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Special Stain Group Ii,,,,, $120.84 , $120.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Special Stains Group I,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Special Stains Group Ii,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abdomen 2 Views,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abdomen 3 Views,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abdomen IV (Kub),,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abdomen IV Port,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abdomen One View,,,,, $360.00 , $360.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $869.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ac Joints Bi,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ankle Complete,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Athrect Periph Artery,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Barium Enema,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Barium Enema Red Svc,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Barium Swallow,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biliary Stone Extraction,,,,, $673.00 , $673.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Age Studies,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Density Dexa,,,,, $633.00 , $633.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Survey Limited,,,,," $1,132.00 "," $1,132.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Breast Needle Local,,,,," $1,336.00 "," $1,336.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Breast Surgical Specimen,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronchography Bi X&i,,,,," $1,106.00 "," $1,106.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $991.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 "," $1,281.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 "," $1,265.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 "," $2,238.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $852.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $670.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Clavicle Complete,,,,, $373.00 , $373.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $753.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diskographylumbar S&i,,,,," $1,339.84 "," $1,339.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abdomen Complete,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ankle 2 Views,,,,, $347.00 , $347.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elbow 2v Comp,,,,, $309.52 , $309.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elbow Min 3v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Embolization Therapy,,,,," $8,848.00 "," $8,848.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Embolization Therapy S&i,,,,," $5,008.00 "," $5,008.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hip Min 2v,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foot Min 3 Views,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Forearm 2 Views,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand 2 Views,,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hip Operative Proc,,,,, $939.16 , $939.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Min 3 Views,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $334.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hip Unilat 1 View,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $576.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ercp Biliry Duct,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Esoph With Video,,,,, $890.40 , $890.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Esophagus,,,,, $557.56 , $557.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eye for Fb,,,,, $387.96 , $387.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Facial Bone 3 Views,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Femur Min 2views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Film Copy X-Ray,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $446.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 "," $1,691.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flouro More 1 Hour,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoro Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fluoro W/O Film,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foot 2 Views,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humerus Min 2v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 "," $1,105.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $475.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ivp Retrograde,,,,," $1,017.60 "," $1,017.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $948.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 "," $1,013.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ivus Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee 3 Views,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee Min 4v,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mandible 1-3v,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mandible Min 4v,,,,, $545.90 , $545.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $492.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 "," $2,428.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 "," $2,308.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 "," $2,134.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Neck Soft Tissue,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nephrostogram,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 "," $1,580.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Optic Foramina Exam,,,,, $690.06 , $690.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orbits 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orbits 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Panorex,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pelvimetry,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 "," $1,297.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 "," $3,047.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $709.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renal Angio Bilat,,,,," $3,838.26 "," $3,838.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renal Catheter Placement,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $715.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scapula (2 Views),,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scapula Complete,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sella Turcica,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoulder 1 View,,,,, $374.18 , $374.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sialography S&i,,,,, $601.02 , $601.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinuses <3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinuses 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinuses Waters View,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skull 1-3 Views,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skull Min 4v,,,,, $648.72 , $648.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Small Bowel Series,,,,," $1,602.72 "," $1,602.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $849.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $640.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Thoracic 2v,,,,, $570.28 , $570.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sternum 1v,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sternum 2 Views,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Subtraction Study,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Svc,,,,," $1,161.76 "," $1,161.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tmj Bi,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tmj Unilat,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Toes 2 Views,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 "," $1,619.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 "," $2,174.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $910.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 "," $2,999.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Upper Gi,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Upper Gi W/Air,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Upper Gi W/Kub,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ureter Stent Placement,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 "," $1,048.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 "," $1,495.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 "," $1,827.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venography Caval Inferio,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wrist 2 Views,,,,, $288.32 , $288.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xray Reading Outside,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zygomatic Arch,,,,, $393.26 , $393.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,A/C Joints Bilateral,,,,, $205.00 , $205.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ankle Ap & Lat,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Coccyx,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colon Barium,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Colon Barium W/Air,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cystogram S&i,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elbow Ap & Lat,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elbow Complete,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Elbow Complete I/F,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foot Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foot Complete I/F,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Forearm 1 Joint,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Complete I/F,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hand Two Views,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hip 2 Views I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hip Uni Two Views,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Facial Bones Comp,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Femur,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fingers,,,,, $198.00 , $198.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foot Ap & Lat,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Humerus,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee 2 Views I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee Ap and Lateral,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Knee Completed,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kub,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mandible Complete,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mandible Copl I/F,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mandible Limited,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mastoid Complete,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nasal Bones Only,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Os Calcis,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pelvis 2 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pyelogram Retro,,,,," $1,762.00 "," $1,762.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ribs Bilateral,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ribs Unilateral,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sacroiliac,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sacrum,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scapula,,,,, $216.00 , $216.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoulder 3 Views,,,,, $335.00 , $335.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoulder Compl I/F,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Shoulder Limited,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinuses Complete,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sinuses Limited,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skull Complete,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skull Complete I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skull Limited,,,,, $261.00 , $261.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $330.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Cervical Compl,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Lumb Complete,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sternaclavc Jnts,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sternum,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tempmndublr Jnts,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tibia and Fibula,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Upper Gi Series,,,,, $609.00 , $609.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venogram Unilateral,,,,," $3,111.00 "," $3,111.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wrist Ap & Lat,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wrist Complete,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bladder Scan,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Contrast Xray Uniary,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Foot Complete 3 Views,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orbit X-Ray,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 "," $3,972.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 "," $3,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Aortic Arch,,,,," $2,463.44 "," $2,463.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 "," $1,564.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 "," $1,187.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 "," $3,897.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 "," $1,618.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 "," $3,420.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 "," $2,921.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Carotid CPT,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 "," $2,033.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 "," $3,864.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 "," $3,117.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 "," $3,878.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 "," $3,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Renal Unilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Retro Brachial,,,,," $1,313.34 "," $1,313.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 "," $2,079.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 "," $1,248.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Visceral S&i,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 "," $3,919.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angiography Spinal S&i,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 "," $2,784.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 "," $2,119.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplasty Periph Art,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 "," $2,226.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arthrography Hip S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arthrography Knee S&i,,,,," $1,246.00 "," $1,246.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 "," $1,253.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Artho Shoulder,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 "," $2,454.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aorta Abdominal,,,,," $4,554.00 "," $4,554.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 "," $3,069.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 "," $3,842.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aortoram Abdominal,,,,," $1,210.52 "," $1,210.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest 1 View I/F,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Complate 4 Views,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Inspir/Exp,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Lat Decub,,,,, $438.00 , $438.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Pa 2 Views,,,,, $556.00 , $556.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Pa Single View,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Port,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest One View,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Three Views,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chest Two Views,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 "," $7,310.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $924.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Imaging Spect,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 "," $2,138.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 "," $1,503.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $889.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cisternography,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liver Funct Study,,,,," $2,514.32 "," $2,514.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Liver Scan (Spect),,,,," $2,047.92 "," $2,047.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lung Perfusion,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Lung Ventilation Scan,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 "," $1,576.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 "," $5,828.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 "," $3,110.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Parathyroid Scan,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Scan White Blood Cell,,,,," $3,372.92 "," $3,372.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 "," $2,176.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Schilling Test W/Factor,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 "," $1,020.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Testicular Imaging,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 "," $2,054.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 "," $2,684.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 "," $1,241.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tumor Local Spect,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tumor Local Whole Body,,,,," $2,575.80 "," $2,575.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastric Emptying Scan,,,,," $5,148.42 "," $5,148.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 "," $5,990.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 "," $2,805.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastrographin Liquid,,,,, $434.60 , $434.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Chest W/Con,,,,," $4,525.14 "," $4,525.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 "," $4,650.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 "," $1,108.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 "," $4,091.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Pelvis W/Con,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Facial W/O,,,,," $1,693.00 "," $1,693.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 "," $2,254.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 "," $7,418.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 "," $1,682.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Head W/Contrast,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Head W/O Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 "," $1,966.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Iac W/O Cont,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 "," $2,941.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Neck W/Contrast,,,,," $2,894.86 "," $2,894.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 "," $3,922.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $673.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Crystal Analysis,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Abd W/Con,,,,," $2,140.14 "," $2,140.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Abd W/O Con,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 "," $3,997.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Guided Needle Loc,,,,," $2,268.40 "," $2,268.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 "," $7,174.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $842.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 "," $1,992.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 "," $3,739.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 "," $3,963.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 "," $4,854.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 "," $2,595.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 "," $3,561.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 "," $3,587.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Needle Bx,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $384.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Extremity CPT,,,,, $961.42 , $961.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Peripheral CPT,,,,," $5,450.52 "," $5,450.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Renal,,,,," $3,396.24 "," $3,396.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angio Visceral CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 "," $4,096.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 "," $5,325.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplasty Iliac,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aorta Catheterization,,,,, $934.92 , $934.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aortogram Abd CPT,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Appl Unna Boot,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 "," $5,719.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 "," $3,491.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 "," $1,179.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherect Aorta Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 "," $3,442.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 "," $2,444.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 "," $2,200.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Lung,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $785.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $951.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 "," $1,744.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronchography Uni S&i,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 "," $2,339.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bx of Kidney CPT,,,,, $952.94 , $952.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 "," $3,093.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 "," $7,648.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 "," $7,369.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 "," $1,509.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $913.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 "," $3,933.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Central Venous Cath,,,,, $289.38 , $289.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $634.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 "," $2,374.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 "," $1,955.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Embol Extracranial CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Embolization CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $392.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ercp Radiology CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 "," $3,265.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $698.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,I&d Cyst Complex,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,I&d Cyst Simple,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 "," $1,930.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ins Chest Tube,,,,, $642.36 , $642.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insert Central Line Percu,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 "," $3,279.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 "," $4,208.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 "," $2,903.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 "," $5,344.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 "," $3,210.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $786.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $659.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $531.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 "," $3,668.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 "," $2,935.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 "," $2,024.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 "," $1,605.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 "," $2,245.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 "," $7,211.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 "," $3,402.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 "," $1,904.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $864.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 "," $3,612.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $899.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 "," $3,793.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Replc Picc Only Surg,,,,," $2,452.84 "," $2,452.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reposition Leads,,,,," $3,916.70 "," $3,916.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skin Biograft,,,,," $1,718.26 "," $1,718.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Skin Biograft Add-On,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Split Skin Graft,,,,," $3,782.08 "," $3,782.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Stent Placement,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 "," $1,386.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thoracentesis,,,,, $804.54 , $804.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 "," $2,257.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 "," $2,378.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 "," $2,167.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tissue Graft Other,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tracheostomy Planned,,,,," $3,892.32 "," $3,892.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 "," $1,170.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 "," $1,092.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 "," $3,390.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,General Anesthesia,,,,," $2,207.98 "," $2,207.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 "," $1,138.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $98.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Blood Admin,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Transfuse Blood Products,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Echo Routine,,,,, $768.50 , $768.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ultrasound Extremity,,,,," $1,598.48 "," $1,598.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Renal Sonogram,,,,," $1,749.00 "," $1,749.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 "," $2,414.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mammogram Special,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Echo Color Doppler,,,,, $703.84 , $703.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Echograhy Transrectal,,,,, $858.60 , $858.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 "," $1,080.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 "," $2,186.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Abdomen Complete,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Abdomen Limited,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Aorta,,,,," $1,011.24 "," $1,011.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Breast Bilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Breast Uni,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Gallbladder,,,,, $675.22 , $675.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 "," $6,321.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Kidney,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Pelvic Complete,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Pelvic Limited,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Retro Limited,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Scrotum,,,,, $747.30 , $747.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Thyroid,,,,, $711.26 , $711.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Transvaginal,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Us Chest,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Us Guide Vascular Access,,,,," $1,134.20 "," $1,134.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Us Kidney,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 "," $1,867.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Abg,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accapella Setup,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Accapella Treatment,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Arterial Puncture,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 "," $1,183.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronch Ther-Initial,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronch Ther-Subs,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronch With Biopsy,,,,," $1,828.00 "," $1,828.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bronch With Brushing,,,,," $1,620.00 "," $1,620.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $798.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Cpr-Code Blue,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Diag Bronch,,,,," $1,286.00 "," $1,286.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Intubation,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mdi Setup,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mdi Treatment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxygen Per Day,,,,, $359.00 , $359.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxygen Setup,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Patient Education,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peak Flow,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pft Pre & Post,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pft Simple,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulse Ox Setup,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rt Assessment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sputum Induction,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suction,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suction Set Up,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Updraft Set Up,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Updraft Treatments,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Vent Check-Daily,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPAP,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,CPAP Mask,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mdi,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Non Rebreather,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxygen Mask,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Suction Equip Daily,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Portable O2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulse Oximeter,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Prosthetic Training 15min,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Massage,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Re-Eval,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Therapeutic Proc,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT-E-Stim,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT-Wheelchair Main,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sensory Integration 15min,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Gait Training 15 Min,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Kinetic Excercises,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Evaluation,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Therap Group 15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Physical Ther. Activities,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Physical Therapy Procedures,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Evaluation/-Go,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Adl 15-Min,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $407.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $282.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Re-Eval - Go,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Tens Application - Go,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Speech Therapy,,,,, $308.46 , $308.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $618.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Speech Therapy Eval,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Swallow Clinical Eval,,,,, $854.00 , $854.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 "," $1,242.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 "," $1,745.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $754.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Echo 2d&m Complete,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Echo D&m Limited,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $489.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Echo Cardiogram,,,,," $4,562.00 "," $4,562.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Ambulance One Way,,,,," $1,214.76 "," $1,214.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Abd W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 "," $7,515.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 "," $6,315.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 "," $4,867.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 "," $6,631.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Brain W/Cont,,,,," $5,235.34 "," $5,235.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 "," $14,057.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Add'l Levels,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,MRI Head,,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mra Head Wo Cont,,,,," $1,312.28 "," $1,312.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 "," $1,906.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,General Recovery,,,,," $1,500.00 "," $1,500.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EKG,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EKG Rhythm Strip,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Electrocardiogram,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 "," $1,215.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 "," $1,196.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EEG Sleep Only,,,,," $1,587.88 "," $1,587.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 "," $1,988.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Mslt,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polysomnography W CPAP,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polysomnography W/4+param,,,,," $5,587.26 "," $5,587.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 "," $6,984.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EEG,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Hemodialysis,,,,, $549.08 , $549.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Peritoneal Dialysis,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Nursing Assessment,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Patient Education Group Sessio,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Educational 60 Mi,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Training Education 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 "," $4,011.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Tcp02,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,EMG Electromyograph,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Cigna Health Plan,Cigna,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Private Room,,,,," $1,083.00 ", $-   , $-   ," $1,200.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Self Pay,Uninsured,DRG,,Semi-Private Room,,,,," $1,051.00 ", $-   , $-   ," $1,200.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Self Pay,Uninsured,DRG,,ICU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,400.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Self Pay,Uninsured,DRG,,CCU-Room,,,,," $3,428.00 ", $-   , $-   ," $1,400.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Self Pay,Uninsured,DRG,,Inpatient Geri Psych Semi-Private Room,,,,," $1,237.00 ", $-   , $-   ," $1,200.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Self Pay,Uninsured,DRG,,Inpatient Geri Psych Private Room,,,,," $1,423.00 ", $-   , $-   ," $1,200.00 ",,,Plan pays daily Per Diem Rate Pro Fees not included
Self Pay,Uninsured,HCPC's,90832,Individual Psychotherapy 30 Mi,,,,, $250.16 , $-   , $-   , $250.16 ,,,Pro fees not included
Self Pay,Uninsured,HCPC's,90834,Individual Psychotherapy 45-5,,,,, $501.38 , $-   , $-   , $501.38 ,,,Pro fees not included
Self Pay,Uninsured,HCPC's,90853,Group Psychotherapy,,,,, $326.00 , $-   , $-   , $326.00 ,,,Pro fees not included
Self Pay,Uninsured,DRG,4,"Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R",,,,," $990,140.50 ", $-   , $-   ," $114,800.00 ",,,Dailey Per Diem Avg LOS 82 days Pro Fees not included
Self Pay,Uninsured,DRG,57,Degenerative nervous system disorders w/o MCC,,,,," $40,526.47 ", $-   , $-   ," $19,200.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Self Pay,Uninsured,DRG,177,Respiratory infections & inflammations w MCC,,,,," $125,842.83 ", $-   , $-   ," $30,800.00 ",,,Dailey Per Diem Avg LOS 22 days Pro Fees not included
Self Pay,Uninsured,DRG,189,Pulmonary edema & respiratory failure,,,,," $176,017.44 ", $-   , $-   ," $37,800.00 ",,,Dailey Per Diem Avg LOS 27 days Pro Fees not included
Self Pay,Uninsured,DRG,207,Respiratory system diagnosis w ventilator support 96+ hours,,,,," $318,933.03 ", $-   , $-   ," $43,400.00 ",,,Dailey Per Diem Avg LOS 31 days Pro Fees not included
Self Pay,Uninsured,DRG,208,Respiratory system diagnosis w ventilator support <96 hours,,,,," $116,758.95 ", $-   , $-   ," $19,200.00 ",,,Dailey Per Diem Avg LOS 16 days Pro Fees not included
Self Pay,Uninsured,DRG,870,Septicemia w MV 96+ hours,,,,," $324,965.94 ", $-   , $-   ," $42,000.00 ",,,Dailey Per Diem Avg LOS 30 days Pro Fees not included
Self Pay,Uninsured,DRG,871,Septicemia w/o MV 96+ hours w MCC,,,,," $163,739.99 ", $-   , $-   ," $49,000.00 ",,,Dailey Per Diem Avg LOS 35 days Pro Fees not included
Self Pay,Uninsured,DRG,949,Aftercare W Cc/Mcc,,,,," $142,461.17 ", $-   , $-   ," $58,800.00 ",,,Dailey Per Diem Avg LOS 42 days Pro Fees not included
Self Pay,Uninsured,DRG,884,Organic Disturbances & Mental Retardation,,,,," $20,776.82 ", $-   , $-   ," $10,800.00 ",,,Dailey Per Diem Avg LOS 9 days Pro Fees not included
Self Pay,Uninsured,DRG,885,Psychoses,,,,," $22,724.68 ", $-   , $-   ," $13,200.00 ",,,Dailey Per Diem Avg LOS 11 days Pro Fees not included
Self Pay,Uninsured,DRG,,Vent Check-Daily,,,,, $32.00 , $-   , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vent Circuit,,,,, $100.70 , $-   , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventilator Mgmt Ea Sub Day,,,,, $523.00 , $523.00 , $-   , $200.00 ,,,Additional daily fee Pro fees not included
Self Pay,Uninsured,DRG,,Ventilator Mgmt First Day,,,,, $746.00 , $746.00 , $-   , $200.00 ,,,Additional daily fee Pro fees not included
Self Pay,Uninsured,DRG,,Interrupted Stay,,,,, $-   , $-   , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Code Blue,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,.45% Nacl 1000 ML,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,0.9% 10ml Flush,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,0ocusate (Colace) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,0terile H20 760ml W/O Humifada,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,10ml Control Syringe,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"12"" Abdominal Binder",,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,14fr Stylet Slip,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,18 Inch Suction Tubing 5mm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,1eppra 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,1ray Foley Cath 14fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,2 3/4  Wafer,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,21 Lnr Ps,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,24 Hour Abp Monitor,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,24fr Straight Thoracic Cath,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,24hr Varprevent Oral Care Kit,,,,, $189.74 , $189.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,250ml Bolus Ns,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"3"" Microfoam Tape",,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,300cc Collection Canister,,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,32 Fr Thoracic Catheter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,340 Measure Volume,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"4"" Kerlick",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"4""ctr PT Lk Colostommy Bg Clam",,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"4""drainable Pouch",,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,48  Press Moniter Line,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,4x4 Alldress Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,5 X 9 Abd Pad,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,60cc Catheter Tip Syringe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"90 Grams Bactroban,nyst,calmos",,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,A&d Ointment,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,A/B Otic Drops,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,A/C Joints Bilateral,,,,, $205.00 , $205.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aa 4.25%/D10w/Electr(Clinimix,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aa 4.25%/D25w (Clinimix) 2000m,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aa 4.25%/D25w/Electr(Clinimix,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aa 4.25%/D25w/Electrolytes (Am,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aa 4.25%/D5w/Electr(Clinimix E,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aa 5%/D20w/Electr(Clinimix E),,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ab Encephalitis California,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ab Encephalitis West Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abacavir (Ziagen) 300mg Tab,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abd Pad 5x9 ST 36/Tr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abd Pads 8 X 10,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abdomen 2 Views,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abdomen 3 Views,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abdomen Acute W/Pa Chest,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abdomen Complete,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abdomen IV (Kub),,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abdomen IV Port,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abdomen One View,,,,, $360.00 , $360.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abdominal Binder  Unisiza,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abduction Wedge,,,,, $551.60 , $551.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abelcet 250mg/Dextrose5/200ml,,,,," $3,051.00 "," $3,051.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abelcet 300mg/Dextrose 5% 240m,,,,," $3,244.00 "," $3,244.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abg,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 15 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 2 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 2.5 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 20mg Tablet,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 30 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 5 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 7.5 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify 9.75mg Injection,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abilify Inj 7.5mg/ML,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abras Ea Add 4 Lesion or Less,,,,, $384.78 , $384.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abrasion Sgl Lesion,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abreva Cream 2gm,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abs Fistula Sinus Tract S&i,,,,, $869.00 , $869.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Abscess Drain Periton Closed,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ac Joints Bi,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acamprosate Calc 333,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acarbose (Precose) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acarbose 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accapella Setup,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accapella Treatment,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accolate 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accu Check Cmfrt Curv 100,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accucheck,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accupril 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accupril 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accupril 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accupril 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accuzyme Oint,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Accuzyme Oint 30gm,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ace Bandage,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ace Wrap 4 Inch,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ace Wrap 6 Inch,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acebutolol 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acebutolol 400 Mg,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen 120mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen 325mg Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen 500,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen 500 Mgl,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen 650mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen 650mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen Infant Drps 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen/Caffeine/Butalba,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen/Codeine,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetaminophen/Codeine Tab 300m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetazolamide 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetazolamide 500mg,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetic Acid 0.25% Irr 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetic Acid Ear Drps 2% 60 ML,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Acetone, Quant",,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetylcholine Recep,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetylcholine Recept Blocking,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetylcholine Receptor Binding,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetylcysteine (Mucomyst) 20%,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetylcysteine 10% (Mucomyst),,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ACETYLCYSTEINE 10% VIAL,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acetylcysteine 30 ML Vial 20%,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acidophillus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ACIDOPHILUS CAPSULE,,,,, $15.18 , $15.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aciphex 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ACT DRY MOUTH LOZ,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Actaminophen,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acth,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acth Treatment,,,,, $467.46 , $467.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acticoat Burn Dressing (3 Day),,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Activity Therapy 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acto Plus 15/850mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Actonel 150 Mg Tab,,,,, $634.00 , $634.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Actonel 35 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Actos 15 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Actos 30 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Actos 45mg,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acular Opth Sol'n 5m,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acular Sl 4% Opth Sol 5 ML Bot,,,,, $559.00 , $559.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acyclovir 200 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acyclovir 200mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acyclovir 400 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acyclovir 5% Cream,,,,, $632.00 , $632.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acyclovir 500mg Inj,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acyclovir 800 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acyclovir Oint 5gm,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Acyclovir Susp 200mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adapt 28-98% F/Large Vol Nebul,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adapter T,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Adapter, Oxygen Tubing 22mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Adapter,multi,15mm Idx22mm Od",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adapternutandnippleoxygenunive,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adapterventilator15mmidx22mmod,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adaptic Dressing 3x8,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adaptic Non-Adhering Dressing,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Add Fee-Ivp-B,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adderall 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adderall 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adenosine  6mg Syri,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adenovirus Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adhesive Remover Wipes 50/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adipex-P ER Tab 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Admin Fee Blood Bank,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ADMIN FEE FRESH FROZEN PLASMA,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Admin Set Nitroclyc Intrlnk,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Admission Set Up,,,,, $831.04 , $831.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adult Pullups Large,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adult Pullups Medium,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adult Pullups Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adult Spo2 Sensor,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Adult Wipes,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advair,,,,, $408.00 , $408.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advair Discus 250/50,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advair Diskus 100/50,,,,," $1,128.00 "," $1,128.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advair Diskus 500/50,,,,," $1,855.00 "," $1,855.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advair Diskus Inh,,,,, $819.00 , $819.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advair Hfa 115/21,,,,," $1,391.00 "," $1,391.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advanced Eye Relief,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advil 200mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advil Congest Rel,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Advil Pm,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aero/Vapor Inhal Sub,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aerobic Bacterial Culture,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aerobid,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aerochamber,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Af N Men A/Y,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Afb Culture,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Afb ID Direct Probe,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Afb Sensitivity,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Afrin  .05 Spr,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aft Smear Only,,,,, $193.98 , $193.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ag Giardic Antigen Eia,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ag N Men B/E Coli,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ag N Men C/U,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aggremox Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aggrenox 25/200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aggrenox ER Caps,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Air Hose Disposable,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Air Hose Reusable,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Air Mattress,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Airway Guedel 70mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Airway Guedel 80mm,,,,, $6.28 , $6.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Airway Nasopharyn Pvc 32 Fr,st",,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Airway Nasopharyngeal Pvc 24fr,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Airway, Guedel, 100mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Airway, Guedel, 90mm",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Airway,nasopharyn,pvc,28frstrl",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Airwaynasophary,robertazzi28fr",,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Airwaynasopharynargyle26frstrl,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Airwaynasopharyngealpvc32frstl,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Akwa Tears,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Akwa Tears 1.4%,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ala Mag 30 Ea Liq,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alaway Eye Drops,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albumin 25gm 100ml,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albumin 25gm Vl,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albumin Body Fluid,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albumin Serum,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol .83mg/ML 75,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 0.083% 3ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 0.083% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 0.5% Neb Soln,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 2.5/3ml Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 2.5mg HHN,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 200 Metered 17 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 2mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 4 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 90 Mcg Aer,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol 90mcg Inh 17gm,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol Bulf Inh H 0.8,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol Inhaler,,,,, $293.00 , $293.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol Inhaler 8,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol Sulf/Iprat(Duoneb) N,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol Sulfate ER (Vospire),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol/Ipratop Inh,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Albuterol/Ipratropium(Combiven,,,,, $745.00 , $745.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alclometsone (Aclovate) Crm 0.,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alcohol Blood,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alcohol Lg Prep Pad,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alcohol Prep Pads,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alcohol Preps,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alcohol Urine,,,,, $301.04 , $301.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aldactone 25mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aldactone 50 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aldolase,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aldosterone Bld,,,,, $938.10 , $938.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alendronate (Fosamax) 10mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alendronate 35 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alendronate 35mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alendronate 70 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alendronate Sodium 70mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alendronate/Vit D (Fosamax D),,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aleve,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aleve 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alfuzosin (Uroxatral) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alfuzosin HCL 10 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Algidex Ag Gauze,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Align,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alk Phos Isoenzymes,,,,, $443.08 , $443.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alk Phosphatose Bone Specific,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alkaline Phosphatas,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allanenzyme Oint 30 Gm Tube,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allantoin/Onion/Peg (Mederma),,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alldress Dressing,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allegra 180 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allegra 60 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allegra 600 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allegra D 24hr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allegra-D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allevyn 4x4 Foam Dressing,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allevyn 4x4 Thin Dressing,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allopurin0l 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allopurinal 300mg/Shein,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allopurinol 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allopurinol 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Allopurinol 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Almotriptan Malate (Axert) 12.,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alocromil 2% 5ml Eye,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aloe Vera Gel 12oz,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aloe Vesta Protective Ointment,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ALONDRENATE 70 MG,,,,, $13.16 , $13.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alosetron 1mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ALPHA LIPOC ACID 200 MG,,,,, $3.50 , $3.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alpha-1-Antitrypsiniphe,,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alpha-Fetoprotein Amnio,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alpha-Fetoprotein Serum,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alphagan 0.2% Drops,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alphagan P O. 15% 5 ML,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alphagan Sol 0.1%,,,,, $460.00 , $460.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alprazolam (Xanax) .25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alprazolam (Xanax) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alprazolam .125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alprazolam 0.25mg/Purepac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alprazolam 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alprazolam 1mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alprazolam 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Altace 1.25 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Altace 10 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Altace 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Altace 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Alteplase Vl 1mg,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aluminum Hydroxide/Amphojel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amalactin Xl Lotion,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amantadine 100 Mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amantadine 70 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amaryl 0.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amaryl 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amaryl 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amaryl 4 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ambien 10mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ambien 2.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ambien 5mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ambien Cr 12.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ambien Cr 12.5 Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ambilify 10 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amblify 15 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ambulance One Way,,,,," $1,214.76 "," $1,214.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amikacin,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amikacin 250 Mg Im,,,,, $613.00 , $613.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amikacin 500 Inj,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amikacin 500mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amiloride 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amino Acid 8.5% (Aninosyn) 500,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amino Acids 10% (Freamine) 500,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amino Acids 10% (Travasol) 500,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amino Acids 15% (Aminosyn Ii),,,,, $374.00 , $374.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amino Acids 5.4% (Nephramine),,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amino Acids 8% (Hepatasol) 500,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aminocaproic Acid 250mg/ML 2ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aminophylline Ftv : 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aminosyn Rf 5.2%/D70w,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amiodarone (Cordarone) 150mg A,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amiodarone (Pacerone) 200mg Ta,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amiodarone 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amiodarone 900mg/18ml Vial,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amiodarone HCL 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amiodarone HCL 200 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amiodorone,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitiza 24 Mcg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitiza 8 Mcg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptylin HCL 100mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline (Elavil) 10mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline 12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline HCL 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline HCL 10x21,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amitriptyline HCL 50mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlactin Lotion,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine (Norvasc) 2.5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine (Norvasc) 5mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine Besy 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine Besylate 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine Besylate 10/160 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine Besylate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AMLODIPINE/ATORVAST 10/20 MG,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine/Benazepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine/Benz 10/20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine/Benz 10/40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine/Benz 5/10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine/Benz 5/20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine/Benzapril5/20lotrel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlodipine/Benzepril (Lotrel),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AMLODIPINE/VALSARTAN 10/320 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AMLOD-VALSA-HCTZ 10/160/25 MG,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amlopidine-Benaz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amloride 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ammonia Blood,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ammonium Lact Lotion,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ammonium Lactate (Amlactin) 12,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ammonium Lactate 2% 400gm,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ammonium Lactate 225 Gm,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ammonium Lactate 400gm,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amniostat,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoebic Antibody Screen,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amox / Clauv 500/125mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amox Trk Clv 875/125 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AMOXAPINE 100 MG,,,,, $11.32 , $11.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AMOXAPINE 50 MG,,,,, $5.68 , $5.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicil Clav Pot A 500,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicil/Clavul 100cc Bottle,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin  250mg/5ml,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin (Amoxil Chew) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin 500mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin 875mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin Trihydrate 250,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin Trihydrate 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin/Clav K. 875/125,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin/Clavul (Augmentin),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin/Clavul 250/125 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amoxicillin/Clavulan (Augmenti,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amphetamine,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amphetamine Salt 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AMPHETAMINE SALT 20 MG,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amphetamine Salt 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AMPHETAMINE SALT CMB 15 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amphotericin B 50mg Inj,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amphotericin B Liposome (Ambis,,,,," $1,026.00 "," $1,026.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin (Principen) 250mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin (Principen) 250mg/5,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin 1 Gm Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin 1gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin 2gm Inj,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin 500mg/50ml,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ampicillin/Sulbactam (Unasyn),,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amylase Body Fluid,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amylase Isoenzyme,,,,, $723.98 , $723.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amylase Serum,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amylase Urine 2 Hour,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amylase/Lipase/Prote (Creon-20,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Amylase/Lipase/Prote (Pancreas,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ANA Titer & Pattern,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anafranil 25 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Analgestic Creme Rub,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anaspaz Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anastrozole (Arimidex) Tab : 1,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anastrozole 1 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ANBESOL MAX STRENGTH GEL,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anchor Fastener Oral Et Tube,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Androstenedione,,,,, $929.62 , $929.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Adrenal Bilateral,,,,," $3,972.00 "," $3,972.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Adrenal Unilateral,,,,," $3,390.00 "," $3,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Aortic Arch,,,,," $2,463.44 "," $2,463.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Aortic Arch S&i,,,,," $1,564.00 "," $1,564.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Arteriovenous Shunt,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio A-V Shunt S&i,,,,," $1,187.00 "," $1,187.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Caro/Cere Bi,,,,," $3,897.00 "," $3,897.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Caro/Cere Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Caro/Cere CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Caro/Cere Uni S&i,,,,," $1,618.00 "," $1,618.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Caro/Cere Unilat,,,,," $3,420.62 "," $3,420.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Caro/Cerv Bi S&i,,,,," $2,921.00 "," $2,921.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Caro/Cerv Bilat,,,,," $4,876.00 "," $4,876.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Caro/Cerv Uni,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Carotid CPT,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Carotid Uni S&i,,,,," $2,179.36 "," $2,179.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Catheter,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Ext Bi Surgery,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Ext Carotid Bi S&i,,,,," $2,033.08 "," $2,033.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Extrem Unilateral,,,,," $3,864.76 "," $3,864.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Extreme Unit W/Cont S&i,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Extremity Bilateral,,,,," $3,117.00 "," $3,117.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Extremity CPT,,,,, $961.42 , $961.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Pelvic Select/Supraselec,,,,," $3,878.54 "," $3,878.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Peripheral CPT,,,,," $5,450.52 "," $5,450.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Pulmonary Bi,,,,," $3,669.00 "," $3,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Renal,,,,," $3,396.24 "," $3,396.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Renal Unilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Retro Brachial,,,,," $1,313.34 "," $1,313.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Selec Add Vessel S&i,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Selec Ea Add'l Vess,,,,," $2,079.72 "," $2,079.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Select Add Vessel CPT,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Thru Exist Cath for F/U,,,,," $1,248.68 "," $1,248.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Vert/Cerv Intracran,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Via Exist Cth S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Visceral CPT,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angio Visceral S&i,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angiography Ext Carotid Biilat,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angiography Ext Carotid Unilat,,,,," $3,919.88 "," $3,919.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angiography Pulm Non-Select,,,,," $3,682.44 "," $3,682.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angiography Pulm Unilat Select,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angiography Spinal S&i,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplas Aorta Surg,,,,," $4,096.90 "," $4,096.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplas Peri Tib-Per Surg,,,,," $5,325.44 "," $5,325.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplasty Add Perip Art S&i,,,,," $2,784.00 "," $2,784.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplasty Add Visc Art S&i,,,,," $2,119.00 "," $2,119.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplasty Iliac,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplasty Periph Art,,,,," $4,492.28 "," $4,492.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplasty Periph Art S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplasty Venous S&i,,,,," $5,431.00 "," $5,431.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplasty Visceral Art CPT,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angioplsty Renal/Visc Art S&i,,,,," $2,226.00 "," $2,226.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Angiotensin Conv Enzyme,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anidulafungin (Eraxis) 100mg I,,,,," $1,176.00 "," $1,176.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anikacin Inj 250,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ankle 2 Views,,,,, $347.00 , $347.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ankle Ap & Lat,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ankle Complete,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ANORO ELLIPTA 62.5/25 MCG INH,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antacid Susp Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Dna Dbl Strand,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Glomerular Bsmnt Memb Qnt,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Huab,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Jo1 Antibody,,,,, $175.96 , $175.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Neutroph Cytoplas Ab,,,,, $498.20 , $498.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Nuclear Antibody,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Reflux Filter,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Scl 70,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti Yob,,,,," $1,037.74 "," $1,037.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibiotic Ear Sol,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Aspergillus,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Blastomycosis,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Brucella,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Coccidioides,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Dna,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Elution,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Epstein Barr Vca,,,,, $592.54 , $592.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Gliadin Iga/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Gliadin Igg/Ria,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Helicobacter Pylori,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Hiv Western Blot,,,,, $673.10 , $673.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody ID,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody ID Plate Immun Assay,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Influenza Virus B,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Intrinsic Factor,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Leptospira,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Rpn,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Screen,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Sjogren,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antibody Smooth Muscle,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti-Diarrheal Cpl,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antidiuretic Hormone,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antifungal Cream,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antigen Screen Fat's Serum,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antigen Screen/Bl Bank,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antigen Type,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antihistone Ab Quant,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti-Histone Abs,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antioxidant Vitamins,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anti-Phosphatidylserine,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antiphospholipid,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antipyrine&benz Ear Drps Bottl,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antipyrine/Benzocaine Otic Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antireflux Filter,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antiskeletal Muscle-Ab,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antithrombin Iii As,,,,, $771.68 , $771.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Antithrombin Iii; Antigen,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anucort-Hc 25mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Anusol Hc Supp,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aorta Abd W/Bi Iliofem S&i,,,,," $2,454.00 "," $2,454.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aorta Abdominal,,,,," $4,554.00 "," $4,554.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aorta Catheterization,,,,, $934.92 , $934.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aortogram Abd CPT,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aortogram Abdominal S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aortogram Abdominal W/Runoff,,,,," $3,069.76 "," $3,069.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aortogram Thoracic Serial S&i,,,,," $3,842.00 "," $3,842.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aortoram Abdominal,,,,," $1,210.52 "," $1,210.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apap 500 Mg X-Str Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apap/Butalbital (Cephadyn) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apap/Codeine 30/300mg (Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apap/Codeine Elix 12mg/120mg 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apc Resistance,,,,, $258.64 , $258.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aplisol Test Vl  5tu/0.1ml,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aplrazolam 0.5 Mg/Greenstone,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apolipoprotein A,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apolipoprotein B,,,,, $183.38 , $183.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Appl Bilaminate Skinsub 25sqcm,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Appl Bilaminate Skinsub Add 25,,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Appl Unna Boot,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Applic Allograft Ea Add 100cm,,,,," $5,719.76 "," $5,719.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Application Exenograft<100 Cm,,,,," $3,491.64 "," $3,491.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Applicator,chloraprep, 3ml",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Applicator,cottontip,wood 6""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apply Unna Boot Bilat/-Gp,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Apresoline 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,APTIOM 800MG TABLET,,,,, $122.61 , $122.61 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aptt,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aquacel  With Transparent Film,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aquacel Ag Dressing,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aquapak 340 ML Steril Water,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aquaphor 3.5 Oz Oint,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aquaphor 3.5mg Oint,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aquaphor Oint 3oz,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aquaphor Ointment 24/Case,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aranesp 25 Mcg Inj,,,,," $1,656.00 "," $1,656.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aranesp Inj 100mcg/.5ml,,,,," $2,390.00 "," $2,390.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arava 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arformoterol (Brovana) 15mcg I,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arformoterol (Brovana) Inh Sol,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arginaid Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aricept 10 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aricept 23 Mg Tablet,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aricept 5 Mg Tablet,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arimidex 1 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ARIPIPRAZOLAM 7.5 MG,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aripiprazole (Abilify) 10mg Ta,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aripiprazole 10 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aripiprazole 15mg,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ARIPIPRAZOLE 2 MG,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ARIPIPRAZOLE 20 MG,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ARIPIPRAZOLE 30 mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aripiprazole 5 Mg,,,,, $103.00 , $103.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,aripiprazole 7.5 mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ARISTADA 662 MG/2.4 ML-PROG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ARISTADA 882 MG IM,,,,, $3.76 , $3.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arixtra Inj 7.5mg/0.5ml,,,,, $585.00 , $585.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arm Sling,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ARMODAFINIL 150 MG,,,,, $8.08 , $8.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ARMODAFINIL 250 MG,,,,, $6.88 , $6.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Armour 90 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aromasine 25 Mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arsenic Any Source,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arterial Blood Gas Kit,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arterial Cath Line Insert Surg,,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arterial Complete Duplex Lower,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arterial Doppler Ultrasound,,,,," $2,414.00 "," $2,414.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arterial Puncture,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Artho Shoulder,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arthrect Periph Fem/Pop,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arthrocent Aspir/Inj Lrg Jnt,,,,," $1,179.78 "," $1,179.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arthrography Hip S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arthrography Knee S&i,,,,," $1,246.00 "," $1,246.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arthrography Shoulder S&i,,,,," $1,490.00 "," $1,490.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arthrography Wrist S&i,,,,," $1,253.98 "," $1,253.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Arthrotec 75 Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Artificial Saliva Sol : 0.01,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Artificial Tears,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Artificial Tears (Isopto Tears,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Artificial Tears 5 Oz,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Asacol 400 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ascensia Elite #50,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ascorbic Acid (Cenolate) 1000m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ascorbic Acid (Vit C) 500mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ascorbic Acid 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Asmanex Twisthaler,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Asmanex Twisthaler 220 Mcg,,,,, $742.00 , $742.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aso Screen,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aso Titer,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aspercreme,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aspercreme 10%,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,aspercreme w/lidocaine 2 oz,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aspirin (Asa) 300mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aspirin 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aspirin 81mg Chewable Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aspirin Chewable 81mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aspirin Ec (Ecotrin) 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aspirin Ec (Ecotrin) 81mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Asprin 81mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Assist Tech Assess 15 Min,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Astelin Nasal Spray,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Astelin Nasal Spy : 137mcg,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atacand 16 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atacand 32 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atacand 8g,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atarex 25mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atenolol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atenolol (Tenormin) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atenolol (Tenormin) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atenolol 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atenolol 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atenolol 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atenolol 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atenolol HCL 50/25,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherect Aorta Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherectomy Add Periph Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherectomy Add Visc Art S&i,,,,," $3,077.00 "," $3,077.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherectomy Brach/Ceph Surg,,,,," $3,442.88 "," $3,442.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherectomy Fem-Pop Art Surg,,,,," $2,958.46 "," $2,958.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherectomy Iliac Artery Surg,,,,," $2,444.36 "," $2,444.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherectomy Renal Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherectomy Tibroperon Artery,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atherectomy Visc Art Init S&i,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Athrect Periph Artery,,,,," $5,771.00 "," $5,771.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Athrectomy Renal/Visceral,,,,," $3,665.48 "," $3,665.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ativan 0.25 Mg Tab,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ativan 0.5 Im,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ativan 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ativan 1 ML Vial,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ativan 1mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ativan 2 Mg Injectable,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ativan 2mg/ML,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ativan Tab 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atoprine Sulfate Eye Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atorvastatin (Lipitor) 20mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atorvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atorvastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atorvastatin 40 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atorvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atorvastatin 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atracurium Besylate Sdv : 50mg,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ATRIPLA,,,,, $399.80 , $399.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atropine 0.4mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ATROPINE 1% EYE DROPS,,,,, $257.84 , $257.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atropine 1mg Syringe,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atropine Sulfate Sol : 1% O/S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atropine Sulfate Syg : .05mg/M,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atrovent Hfa Inh 200,,,,," $1,242.00 "," $1,242.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atrovent Inhalation,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atrovent Inhaler,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Atrovent Inj Aer 18mcg,,,,, $711.00 , $711.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Attapulgite (Bismatrol) Liq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Augementin Xr 875mg,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AUGMEN/BENTAMETH/D 5% OINT,,,,, $445.64 , $445.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Augmentin 1000 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Augmentin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Augmentin 75 ML Bottle,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Augmentin 875 Mg Tab,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Augmentin Xr Tab : 1000mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Automated Platelet Count,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Automated Reticulocyte Count,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Autopsy Gross & Micro W/Brain,,,,," $2,905.46 "," $2,905.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avalide 150/12.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avandia 2mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avandia 4mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avandia 8 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avapro 150mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avc Vaginal Crm 4oz Tube,,,,, $733.00 , $733.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aveeno Bath,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aveeno Cream 3.5oz,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avelox 400mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avodart 0.5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avulsion Nail Plate Ea Add,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Avulsion Nail Plate Sgl,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Awka Tears 1.4%-15ml,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ayr Nasal Mist,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ayr Saline Nasal Gel,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azathioprine Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AZELASTINE EYE DROPS,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azelastine HCL (Optivar) Drp :,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azelastine Nasal Spray,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azilect 1 Mg,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azilect Tab .5 Mg,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azithromycin (Zithromax IV) 50,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azithromycin (Zithromax) 250mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azithromycin (Zithromax) 600mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azithromycin (Zithromax) Sus :,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azithromycin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azithromycin Tri-Pk 500 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azma Cprt Inhaler,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azmacort,,,,, $607.00 , $607.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azo Cranberry Tab 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azo Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azopt Drp 1%,,,,, $482.00 , $482.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,AZOR 10/40 MG,,,,, $49.76 , $49.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Azor 5/40 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aztreonam (Azactam) Vl : 1gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Aztreonam (Azactam) Vl : 500mg,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,B Naturetic Peptide,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,B.D. Neelde,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,B-1,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,B12 1000 Microgram Im/1 ML,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,B12/Falfe 150fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Baby Powder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacid Capsules,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacitracin 15 Gm,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacitracin Oint,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacitracin Oint 3.5 Gm,,,,, $295.00 , $295.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacitracin Ophth Ont : 500un/G,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacitracin Vl : 50000u,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Baclofen (Lioresal) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Baclofen 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Baclofen 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Baclofen 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Baclofen 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacmin Tab 1,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bact Agigrp B Strep,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacteria Filter,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bacteriostatic Water Mdv,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bactrim Ds,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bactrim Ds 800 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bactroban Oint. 2% 22 Gm,,,,, $401.00 , $401.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bactroban Ointment 2%,,,,, $680.00 , $680.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bag Drainage Aerosol T Adapter,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bag Drainage Urinary 2000ml,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bag Leg Twist-Valve Straps Med,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bag Specimen Bio Ziploc 6x9 Po,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bag,drain Aerosol Y Adaptr 750",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bag,enema W/Slide Clamp Polyba",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bag,enema,w/Slideclamp,polybag",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bag,ice,clamp-Close,4ties,whit",,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bag,pat.setup Respirat 12x16",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bag,quantum,1000ml W/Flush",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bagbedsideplasticwht65x35x11.8,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bagpatientsetuprespiratory1216,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bagspecibiohzdziplock6x9pock,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Balanced Salt Soln (Bss Irriga,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Balsalazide (Colazal) 750mg Ca,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bandage Elastic 6""",,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Elastic Swiftwrap Strl,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Scissors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Self Adherent 1x5,,,,, $8.76 , $8.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Self Adhrnt Coban 4x5,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Self Adhrnt Coban 6x5,,,,, $38.16 , $38.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Surepress Compression,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Surgitube Large,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Surgitube Small,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandage Tubigrip-SZ-F,,,,, $282.92 , $282.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandageelastswiftwrapstrl4x5yd,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bandaid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Barbiturates Confir,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Barbiturates Quant,,,,, $445.20 , $445.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bariatric Bed,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bariatric Bed w/scales,,,,, $300.00 , $300.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bariatric Brief Xxl,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bariatric Lift,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bariatric Wheel Chair,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Barium Enema,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Barium Enema Red Svc,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Barium Enema Therapeutic,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Barium Enema/Air Contrast,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Barium Swallow,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Barrier Film,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bartonella Antibody,,,,, $662.50 , $662.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BASAGLAR 100UNIT/ML KWIKPEN,,,,," $1,548.76 "," $1,548.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Basic Metabolic Panel,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Basin Emsis Mauve 500ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Basin Wash 7.4qt Rect Rose,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Becaplermin (Regranex) Gel : 0,,,,," $1,595.00 "," $1,595.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Beclomethasone (Qvar) 80mcg In,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Beconase Aq Nasal Spray,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bed Air 48,,,,, $119.78 , $119.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bed Air 48  Turning,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bed Pan,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bed, Stryker W/Scales",,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bedpan Fracture Mauve 24 Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bedpan,pontoon/Stack,mauve",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bee Pollen,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Beer 12oz Can,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BELBUCA 150 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BELBUCA 300 MCG,,,,, $37.60 , $37.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BELBUCA 75 MCG,,,,, $24.04 , $24.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Belladonna Aklds/Pb Tab : 16.2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Belladonna Alkds/Pb (Donnatal),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BELSOMRA 10 MG,,,,, $56.24 , $56.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Belt Gait 60inch,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ben Gay,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benadryl 25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benadryl 25 Mg Im,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benadryl 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benadryl 50 Mg Inj,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benadryl Crm 2%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benazepril (Lotensin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benazepril HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benazepril HCL 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benazepril HCL 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benazepril Hctz 20/1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bences Jones Protein,,,,, $449.44 , $449.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benefiber 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benefiber Sugar Feee,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benicar 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benicar 20mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benicar 40 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benicar 40/12.5mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benicar 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benicar Hct 20/12.5 Mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benzocaine (Oragel),,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benzocaine 20% (Orabase B) Pas,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benzocaine/Tetracaine (Cetacai,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benzodiazepines,,,,, $302.10 , $302.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benzonatate (Tessalon) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benzonatate 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztrop 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztropine (Cogentin) 1mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztropine (Cogentin) 1mg/ML,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztropine 0.25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztropine 0.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztropine 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztropine 1 Mg Im,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztropine 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Benztropine Mesylate Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Beta 2 Macroglobulin,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Beta Caroten A/Vit,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Beta Hcg Quant Serum,,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Beta-Carotene (Vit A) 25000 Un,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betadine Sol 8oz,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betadine Swabsticks,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betamethasone 1 Cc Im,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betamethasone 2 Cc Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betamethasone Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betamethasone Dipropi Crm : 0.,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betamethasone Valera Lot : 0.0,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betamethasone Valerat Cre : 0.,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betapace 80 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betaxolol (Betoptic-S) 0.25% E,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bethameth Driprop .5,,,,, $499.00 , $499.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bethamethasone Val Cr 15gm .1%,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bethanechol (Urecholine) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bethanechol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bethanechol 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bethanechol 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bethanechol 50mg,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betoptic S OP Gtt 0.25% 10ml,,,,, $292.00 , $292.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Betoptic S Ophth,,,,, $480.00 , $480.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bevespi Aeros 9-4.8 Mcg HFA AD,,,,," $1,108.00 "," $1,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biaxin 500 Mg,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bicalutamide (Casodex) Tab : 5,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bicalutamide 50mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bicillin L-A Inj 1200000 Units,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bidex 400 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bilateral Carotid Duplex Scan,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bile Urine,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bile Urine Auto,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biliary Drain Change Perc Surg,,,,," $2,200.56 "," $2,200.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biliary Stone Extraction,,,,, $673.00 , $673.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bilirubin Direct,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bilirubin Total,,,,, $122.96 , $122.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bimatoprost (Lumigan) Sol : 0.,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bimatoprost Drp 0.03%,,,,," $1,129.00 "," $1,129.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bio Patch Antimic Dress,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bio Psychosocial Assess 45-60,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biofreeze 4% Gel,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Breast Needle Core CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Liver Perc CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Liver Percutaneous,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Lung,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Perc Abd/Retroperi CPT,,,,, $785.46 , $785.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Perc Abd/Retroperi Sur,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Skin Ea Add Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Skin Sgl Lesion,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biopsy Thyroid CPT,,,,, $951.88 , $951.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biosprolol/Hctz 10/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biotene Mouthwash,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biotin 5000 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biotine Drymouth Rinse,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bipap Disposable Circuit,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bipap/CPAP Init & Mgmt,,,,," $1,183.00 "," $1,183.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisac/Nacl/Nahco/Kcl (Halflyte,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisacodyl (Dulcolax) 10mg Supp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisacodyl (Dulcolax) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisacodyl 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisacodyl 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Biscolax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bismuth Subsalicylate (Kaopect,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BISOPROLO/HCTZ 10/6.25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisoprolol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisoprolol (Zebeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisoprolol Fumarate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bisoprolol/Hctz 5/6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bite Block,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Black Cohosh,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Black Widow Antiveni Vl,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bladder Aspir W/Supra Cath CPT,,,,," $1,744.76 "," $1,744.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bladder Irrigation Set Cysto,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bladder Irrigation Y-Type TUR,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bladder Scan,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Blade,clipper,univeral Medicli",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blanket Bair Hugger,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bld Gases Ph Cord,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bld Gases W/Co-Oximetry,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bld Type Abo/Rh,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bld Type Du,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bleeding Time,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blistex Lip Medex,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blood Admin,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blood Gas Ph Pc02 P02 C02 Hc03,,,,, $546.00 , $546.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blood Occult Perox Qual Other,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blood Pressure Cuff Adt Long,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blood Pressure Cuff Adt Small,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blood Typing Rh (0),,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Blood Typing Rh (D),,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bndge,elas,swiftwrap,sterile",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bodywash/Shampoo 2 In 1 4oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Age Studies,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Density Dexa,,,,, $633.00 , $633.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Imaging 3 Phase,,,,," $7,310.82 "," $7,310.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Imaging Limited Area,,,,, $924.32 , $924.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Imaging Spect,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Imaging Whole Body,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Marrow Inter Only,,,,, $230.02 , $230.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Marrow Studies,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bone Survey Limited,,,,," $1,132.00 "," $1,132.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Boniva Tab 150,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bookshelf, Metal Black 81x35",,,,, $359.34 , $359.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Boost,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Boot Ankle Contracute,,,,, $380.00 , $380.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bordered Gauze Dressing 6x6 Pd,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bordetella Pertussis,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bornchoscopy Brush/Wash,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bottle 100ml Saline,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Botulinum Toxin (Botox) Vl : 1,,,,," $3,169.00 "," $3,169.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Boudreauxs Butt Butter,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Boyster Shell Calcium D-500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bp Cuffs Medium,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bracket  Mounting,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brain Imaging Complete Static,,,,," $2,138.02 "," $2,138.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brain Imaging Limited Static,,,,," $1,503.08 "," $1,503.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brain Scan Tomograp Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Breast Needle Local,,,,," $1,336.00 "," $1,336.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Breast Surgical Specimen,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BREATHE RIGHT NASAL STRIPS,,,,, $2.16 , $2.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Breo Ellipta 100/25mcg (puff),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BREO ELLIPTA 200/25 MCG INH,,,,," $1,538.00 "," $1,538.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BREO ELLIPTA INH 100/25,,,,," $1,405.00 "," $1,405.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Bridge,suture Retention",,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brief Adult Large,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Brief,comfort,clothlikelg48/58",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Brief,comfort,clothlikemd32/42",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Brief,comfort,clothlikexl59/66",,,,, $90.10 , $90.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Briefs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Briefs Extra Large,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Briefs Large,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Briefs Medium,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Briefs Small,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BRIEFS XXL PKT,,,,, $41.06 , $41.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BRILINTA 90 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brimonidine 0.2%,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brimonidine 0.2% Eye,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brimonidine Tartrate 5 ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brimonidine(Alphagan P)0.15% O,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brintellix 10 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brinzolamide 1% (Azopt) Sus :,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brompheniramine 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronch Ther-Initial,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronch Ther-Subs,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronch With Biopsy,,,,," $1,828.00 "," $1,828.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronch With Brushing,,,,," $1,620.00 "," $1,620.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Broncho/Therapeutic Aspisubseq,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronchography Bi X&i,,,,," $1,106.00 "," $1,106.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronchography Uni S&i,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronchoscopy Therapeutic,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronchoscopy W/ Brushings,,,,," $2,339.42 "," $2,339.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bronchoscopy W/Biopsy,,,,," $2,355.32 "," $2,355.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brovana 15 Mcg/2 ML Pkg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Brucella Obortus,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bss Irr Soln Sol,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bucks Traction Boot,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Budesonide (Pulmicort) 0.5mg/2,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Budesonide (Pulmicort) 90mcg I,,,,, $508.00 , $508.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Budesonide 0.5 Mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Budesonide 0.5 Mmg/2ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Budesonide Sr (Entocort Ec) Ca,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Budesonide/Formot (Symbicort),,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bumetanide (Bumex) 1mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bumetanide (Bumex) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bumetanide 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bumetanide 2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bumex 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bumex 1mg,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupivacaine (Marcaine) Vl : 0.,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupivacaine 0.25% Inj,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupivacaine 50ml (Marcaine) Md,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupivacaine HCL (Marcaine) Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion,,,,, $587.24 , $587.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion (Wellbutrin Sr) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion (Wellbutrin) 100mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion (Wellbutrin) 150mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BUPROPION 75 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion HCL Sr Tab 150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion HCL Xl 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion Sr (Wellbutrin) 150m,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bupropion Sr N200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspar 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspar 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspar 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspirone (Buspar) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspirone 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspirone 15 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspirone 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspirone 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspirone 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Buspirone 7.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Butal/Ace/Caf (Esgic) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Butalb Cmpd (Fiorinal) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Butalb/Asa/Caff/Cod Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Butalbital/Apap/Cafe 50,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Butalbital/Apap/Caff,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Butorphanol (Stadol) 1mg Inj,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,BUTRANS TRANSD 10 MCG,,,,, $362.00 , $362.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Butterfly Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bx of Kidney CPT,,,,, $952.94 , $952.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bx of Thyroid CPT,,,,, $224.72 , $224.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bydueron 2mg (dose),,,,, $525.00 , $525.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bydueron 2mg (pen),,,,," $1,992.40 "," $1,992.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Byetta 10 Mcg Inj,,,,," $1,086.00 "," $1,086.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bystolic 10 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bystolic 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bystolic 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Bystolic 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,C Peptide,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,C Reactive Protein,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,C02 by Infared Analyzer,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,C1 Esterase,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ca 125,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ca 15-3,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ca 19-9,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ca 27-29,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Caduet 2.5/10 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Caduet 5 Mg/42mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cal Aliginate Dress 4x4.5,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calamine (Calmoseptine) Oint,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calamine/Pramoxine (Caladryl),,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calan 120 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calan 80 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calan Sr 180mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calazime With Olivamine,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcarb 600 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcifediol 25-Oh Vitamin D-3,,,,, $701.00 , $701.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitonin,,,,, $390.08 , $390.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitonin (Miacalcin) 200 Uni,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitonin-Salmon (Miacalcin),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitonin-Salmon Nasal Spray,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitrate 600 + D,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitriol (Rocaltrol) 0.25mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitriol 0.25 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitriol 0.25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CALCITRIOL 0.5 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcitriol 1mcg Inj,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium 250 Mg + D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium 500 Mg + D,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium 600+d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Acet/Alum Su (Domeboro,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Acetate (Phoslo) 667mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Alginate Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Antacid 150 Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Blood,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Carb 500mg/5ml Liquid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Carb 600mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Carb 648 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Carbonate (Tums) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Carbonate 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Carbonate 60,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Chloride 10% Syringe,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Chloride 10% Vl : 0.1,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Gluconate 10% 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Ionized,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Polycarbophil 625,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Tab : 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium Urine 24,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium/Vit D (Caltrate D) 600,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium/Vit D (Os-Cal D) 250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calcium/Vit D (Os-Cal D) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calmoseptin Oint 4 Oz Tube,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Calmoseptine Pks,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Caltrate 500 Mg + D,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Caltrate 600 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Caltrate 600 Mg + D,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Caltrate 600 Plus,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Caltrol 0.25 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Campral 333 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Candesartan (Atacand) 16mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Candesartan 8 MG,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Canister PRO-II Neg Press W/,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cannula Divided 7 Luer,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cannula Etc02,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cannula High Flow,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Cannula, Adult Oxyg 7 Tube Eco",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Cannula,nonflared14tubestarlum",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cap for Peritoneal Dialysis Ca,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Cap, Trach",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Cap,bouffant,proseries,lt Wt",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Capoten 12.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Capoten 25mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Capsaicin Cpm 0.025%,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Captopril (Capoten) 12.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Captopril 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Captopril Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Captopril/Hctz (Capozide) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Captoril 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate 1 Gm Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate 100mg/1ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate 2 Tsp 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate 420 ML Bottle,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate Liquid 140 ML Bottle,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate Liquid 150 Cc Bottle,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate Liquid 210cc Bottle,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate Liquid 280 ML Bottle,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafate Sus 210 ML Bottle,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carafe With Straw,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazepin Sa (Tegretol Xr),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazepine (Tegretol),,,,, $343.44 , $343.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazepine (Tegretol) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazepine 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazepine 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazepine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazepine Chew 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CARBAMAZEPINE ER 300 MG,,,,, $8.52 , $8.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazepine Sa (Carbatrol) C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CARBAMAZEPINE XR 400 MG,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamazine Exilir 240 ML Bot,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamezipine Free,,,,, $237.44 , $237.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamide (Debrox) Ear Drops,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbamide Peroxide (Antisept),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CARBAMIDE PXD 15 ML EAR DROPS,,,,, $14.08 , $14.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbid/Levo/Entac 37.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbid/Levo/Entac 75 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbidopa/Levod/Enta (Stalevo),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbidopa/Levodopa (Sinemet ER,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbidopa/Levodopa (Sinemet) 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbidopa/Levodopa (Sinemet) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbidopa/Levodopa 10/100,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbidopa/Levodopa 25/100,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbidopa/Levodopa 50/200,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbidopal/Levodopa 25/250mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbon Diox Co2,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carbonyl Fe/Fa/B12/C (Icar-C P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carboplatin 450mg (Paraplatin),,,,," $4,211.00 "," $4,211.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carboxyhemoglobin,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Card Blood Pool 1st Pass Sngl,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Card Blood Pool Img Sngl Study,,,,, $889.34 , $889.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Card/Defib Pocket Rev/Rel Surg,,,,," $3,093.08 "," $3,093.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardina 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardiolipin Antibody,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardizem 30 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardizem 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardizem Cd 120 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardizem Cd 180mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardizem Cd 240 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardura 1 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardura 2 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cardura 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carisoprodol (Soma) 350mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carisoprodol 175 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carisoprodol 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carisoprodol 350mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carmex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carmex Lip Ointment,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carotene,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carteolol HCL Sol : 0.01,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Cartridge,toner Brttn550",,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol (Coreg Cr) 10mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol (Coreg) 12.5mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol (Coreg) 3.125mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol (Coreg) 6.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol 12.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol 3.125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol 3.25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol 6.25 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Carvedilol 6.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cascara Sagrada 450 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Casodex 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Caspofungin  (Cancidas) 50mg I,,,,," $2,205.00 "," $2,205.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catapress Tts 0.1 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catapress Tts 0.2 Mg,,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catapress Tts 0.3 Patch,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catecholamines Fract Plasma,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catecholamines Fract Urin,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catecholamines Total Urin,,,,, $710.20 , $710.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath 1st/Abd/Pelvic,,,,," $7,648.96 "," $7,648.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath 2nd/Abd/Pelvic,,,,," $7,369.12 "," $7,369.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Art 1st Order Brach CPT,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Art 3rd/Abd/Pelvic,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Art 3rd/Abd/Pelvic Addl,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Autoguard 20,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath CPT Are 3nd Brachio CPT,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath CPT Art 1st /Abd/Pelv CPT,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath CPT Art 1st Ord Brach CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath CPT Art 3rd Brachid CPT,,,,," $1,509.44 "," $1,509.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath CPT Art 3rd/Abd/Pelv CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath CPT Int 3rd Ord Brach CPT,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath CPT Plc Seg Pulm Art CPT,,,,," $1,105.58 "," $1,105.58 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Foley 16/5 100%sil,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Foley 24/30 Ltx Sil Ctd,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath for Collection,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Intrmt 16 Fr 30/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Intro Av Shunt-Dial Surg,,,,, $464.28 , $464.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath IV 24x3/4 Insyte 50/Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath IV Insyte 18x1.16,,,,, $57.24 , $57.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Lab Tray 18f W/Bag,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Occlude/Embolize Surg,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath of CPT Add 2nd/3rd Vass C,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Pancreatic Duct S&i,,,,, $991.00 , $991.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Placement Renal Veno CPT,,,,, $913.72 , $913.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Sel Thor/Brach 2 Ord Surg,,,,," $1,189.32 "," $1,189.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Select Venous 1 Ord Surg,,,,," $3,933.66 "," $3,933.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Select Venous 2or Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Thoracic 24fr ST,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Tray 14 Fr/Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Tray Foley 16/5 100% Sil,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Tray W/Bag 16 Fr,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Tray W/O Bag,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cath Urethal Tray 14 Fr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter Connector,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter Connector (Blue),,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter Foley Anchor Device,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter IV,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter IV 20gx1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter IV 22gx1 Retractable,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter IV 22x1 Insyte,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter IV Insyte 20gx1.16,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter IV Insyte 24gx.75 ST,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CATHETER MIDLINE,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter Stabilization Device,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Catheter Utrethral 16fr Rr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Catheter, Condom",,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Catheter, Foley",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Catheter, IV 18gx1.16 Ret Str",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Catheter, IV 22gx1 Ret Ster",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Catheter, short term, straight",,,,," $2,543.00 "," $2,543.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Catheter,intermit,apogee 16fr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cauterize Gran Tiss Chemical,,,,, $375.24 , $375.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CBC Complete Automated,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CBC With Auto Diff,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CEA,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cecon Bottle,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefaclor Cap : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefaclor Sus : 125mg/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefaclor Sus : 250mg/5ml,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefaclor Tab : 500mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefazolin Sodium (Ancef) Vl 1g,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefazolin/D5w 50ml Duplex 1gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefazolin/Dextrose (Kefzol) So,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefdinar 300 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefdinir (Omnicef) Cap : 300mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CEFDINIR 300 MG,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefepime (Maxipime) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefepime (Maxipime) 2gm Vl,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefotaxime (Claforan) 1gm Inj,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefoxitin (Mefoxin) 1gm,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefpodoxime (Vantin) 200mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CEFPODOXIME 100 MG,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefpodoxine 200,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefprozil Monohydrat (Cefzil),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftazidime (Fortaz) 1gm Inj,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftazidime (Fortaz) 2gm Inj,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftazidime (Fortaz) 500mg Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftin 250mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftin 500 Mg,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftriaxone (Rocephin) 1gm Vl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftriaxone (Rocephin) 2gm Inj,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftriaxone (Rocephin) 500mg I,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftriaxone 1 Gm,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftriaxone 1 Gm Vial,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftriaxone Inj : 250mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceftriaxone Sodium Inj 250,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefuroxime (Zinacef) 1.5gm Inj,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefuroxime Axetil (Ceftin) Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefuroxime Axetil 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefuroxime Axetil 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefuroxime Sodium (Zinacef) In,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cefzil 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celebrex 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celebrex 200 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celecoxib (Celebrex) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celecoxib 200 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celestone 2 ML Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celestone Mdv : 6mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celestone Soluspan 6mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celexa 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celexa 15 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celexa 20 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celexa 40 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Celiac Disease Antibod,,,,," $1,424.64 "," $1,424.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cell Count Csf,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cell CT/Diff Body Fluid,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cell Total Count,,,,, $636.00 , $636.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cellcept 250mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cellurisc 1%,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Centerpoint Lock Floating Flan,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Centerpointlock Pouch,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Central Line Dressing Kit,,,,, $822.48 , $822.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Central Luman Venous Cath Tray,,,,," $1,068.48 "," $1,068.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Central Venous Access Dev Guid,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Central Venous Cath,,,,, $289.38 , $289.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CENTRATEX,,,,, $4.48 , $4.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Centrum Silver Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Century 50 Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Century Senior Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Century Senior Vitamin,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Century Vite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cepacol Lozenges,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cepacol Throat Spray,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cephalexin (Keflex)  250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cephalexin 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cephalexin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cephalexin Monohydra,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cephalexin Sus : 250mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cerefolin,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cerefolin 1/2 Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cerefolin Nac,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CEROVITE SR TABS,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Certagen 0.4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ceruloplasmin,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cerv Spine Comp I/F,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cetaphil 80z,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cetaphil Mois Lot,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cetirizine (Zyrtec) 10mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cetirizine 10 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cetirizine HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cetuximab (Erbitux) Vl : 10mg,,,,, $314.00 , $314.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cevimeline HCL (Evoxac) Cap :,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cevimeline HCL 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Chair, Wheel Extra Wide",,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Change Nephro/Pyelo Tube,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chantix .5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chantix 1 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Charcoal Liquid  25gm,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Charcoal/Sorbitol Liquid : 25g,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Checkout Orth/Pros 15min,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest 1 View I/F,,,,, $479.12 , $479.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest 2v W/Obliques,,,,, $93.00 , $93.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Complate 4 Views,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Drain Pleur-Evac,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Inspir/Exp,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Lat Decub,,,,, $438.00 , $438.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest One View,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Pa 2 Views,,,,, $556.00 , $556.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Pa Single View,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Port,,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Three Views,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Tube Tray,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chest Two Views,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlamydia Antibody,,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlamydia by Probe,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlamydia Group Ab,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlamydia Trach Dir Probe,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlestyramine Packet,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chloral Hydrate Syp : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chloraseptic Spray,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlordiaz/Amitript (Limbitrol),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlordiazep/Amitript (Librax),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlordiazepoxide (Librium) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlordiazepoxide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlordiazepoxide 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlordiazepoxide 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CHLORDIAZEPOXIDE/CLIDINIUM,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlordiazepxide (Librium) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorex-A Tablets,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorhexidine (Hibiclens) 4% S,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorhexidine (Peridex) Oral S,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorhexidine 0.12% 473 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorhexidine Gluc,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chloride 24hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chloride Blood,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chloride Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chloride Spinal Fluid,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chloride Urine,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorophyll 3mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorphen (Dallergy) Elixir,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorpheniramine 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorpromazine (Thorazine) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorpromazine (Thorazine) 50m,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CHLORPROMAZINE 25 MG,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorpromazine HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorpropamide (Diabinese) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorpropamide Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorthalidone (Hygroton) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorthalidone 12.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorthalidone 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlorthalidone 50mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chlostryamine Pwd Pkg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chng Perc Hep Cath CPT,,,,, $634.94 , $634.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chng Perc Hep Cath S&i,,,,," $1,281.00 "," $1,281.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chol Perc Trans W/Interp,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholan/Pancrea Interaop S&i,,,,," $1,265.00 "," $1,265.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholang Percut/Transhep,,,,," $2,238.00 "," $2,238.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholangiogram T Tube S&i,,,,, $852.24 , $852.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholecysto Oral Contrast,,,,, $670.00 , $670.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholecysto Repeat Exam,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholesterol Hdl,,,,, $201.40 , $201.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholesterol Total,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholestyramine (Questran) 4gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholestyramine Packs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholestyramine Powder,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholinesterase,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cholinesterase Rbc,,,,, $241.68 , $241.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Choloraseptic Throat Spray,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chrom Anal Karyotype,,,,," $1,577.28 "," $1,577.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chromagen Forte,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chromatography Quant,,,,, $461.10 , $461.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chromium 200 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Chromogen Fa 70/150/1 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciclopirox 1% Shampoo,,,,, $370.00 , $370.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cie,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cilostazol (Pletal) 100mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cilostazol 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cilostazol 50 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cilostazol(Pletal)50mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciloxan 3% Eye Drops,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciloxan Opth Drops,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cimetidine 800 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cinacacet (Sensipar) 60mg Tab,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cinnamon 500 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cipro 500mg Tablet,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cipro Hc Ear Drops,,,,, $683.00 , $683.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprodex Otic Sus 7.5,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxac Oph Sol 0.3%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin (Cipro) 0.3% Oph,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin (Cipro) 200mg IV,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin (Cipro) 250mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin (Cipro) 400mg IV,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin (Cipro) 500mg Ta,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin 250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin HCL,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin Opht S 5 ML,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ciprofloxacin/Hc (Cipro Hc) OT,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Circuit, Universal Ippb",,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cisplatin Aqueous Vl : 10mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cistern/C1-C2 Punc for Inject,,,,," $2,374.40 "," $2,374.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cisternography,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cit Acid/Kcitr/Nacit (Cytra-3),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Citalopram (Celexa) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Citalopram 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Citalopram 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Citalopram 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CITALOPRAM 5 MG,,,,, $2.44 , $2.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Citracal Petites,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Citracal Plus W/ Mag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Citrical D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Citrucel Each Scoop,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CITRUS CALCIUM + D 630/500,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cl0nidine 0.1 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clamp Drainable Pouch 20/Bx,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Clamp, Beta",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Clamp, Occluding",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clarinex 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clarithromycin (Biaxin Xl) Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clarithromycin (Biaxin) 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clarithromycin 500mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Claritin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Claritin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Claritin D 5 Mg 24 Hrs,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clavicle Complete,,,,, $373.00 , $373.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clc2000 Catheter Connector,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clean Catch Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clean Presoak Instr Aseptzyme,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLEAR EYES EYE DROPS,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cleocin 150 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Climara 0.1 Mg Patch,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Climara Patch 0.025 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Climara Patch 0.0375 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Climara Patch 0.05 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Climara Patch 0.5 Mg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin (Cleocin T) 1% Top,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin (Cleocin) 150mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin (Cleocin) 600mg (1,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin HCL 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin Inj 600mg/4ml,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin Oint,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin Sol 1% 60 ML Bott,,,,, $385.00 , $385.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin/D5w (Cleocin) 300m,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin/D5w (Cleocin) 600m,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clindamycin/D5w (Cleocin) 900m,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clinical Consult Limited,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clinimix E Sf4.25%-D25% 1000ml,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLOAZPINE 12.5 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clobenzaprine HCL,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clobetasol 15 Gm Tube,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clobetasol Prop Cr 30 Gm,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clobetasol Prop Cream 60 Gm,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLOBETASOL PROP CRM 45 GM,,,,," $1,062.00 "," $1,062.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLOBETASOL TOP SOL 50 ML BOTTL,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clomipramine (Anafranil) 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLOMIPRAMINE 25 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonazepam (Klonopin) 0.5mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,clonazepam 0.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonazepam 1 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonazepam 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonazepam Wafer 0.25,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonazepam/Clozaril,,,,, $549.00 , $549.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine (Catapres) 0.1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine (Catapres) 0.2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine (Catapres-Tts-1) Pat,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine (Catapres-Tts-2) Pat,,,,, $169.00 , $169.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine (Catapres-Tts-3) Pat,,,,, $245.00 , $245.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine .2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine 0.1,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine 0.2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLONIDINE 0.3 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine 0.3mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine Patch .1 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine Tts Patch 0.1 Mg,,,,, $447.00 , $447.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine Tts Patch 0.2mg,,,,, $349.00 , $349.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonidine Tts Patch 0.3 Mg,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clonozapam 0.5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clopidogrel (Plavix) 75mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clopidogrel 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clorazepate (Tranxene) Tab : 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLORAZEPATE 15MG TABLET,,,,, $8.29 , $8.29 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clorazepate 7.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clorpactin 0.4% Solution 500ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clortrim/Betamdipr (Lotris.gen,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clortrimazole Crm 1% 30 Gm,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Closed Suction Tract 14fr Swlv,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clostridium Diff Tox,,,,, $712.32 , $712.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotest/Culture Urine,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrim Antifungal,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole (Lotrimin) 1% Cre,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole (Mycelex) Loz : 1,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole 1%,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole 1%  tube,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole 1% per app,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole 7-Appl Crm : 0.01,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole Crm 1%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole Lozenge 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole/Betameth (Lotriso,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clotrimazole/Betameth 1/0,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clozapine (Clozaril) 100mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clozapine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLOZAPINE 12.5 MG,,,,, $2.32 , $2.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLOZAPINE 25 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CLOZAPINE 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clozaril 100 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clozaril 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clozaril 50 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clozipine 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Clozipine 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cmv Igm Ql,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coagulation Time Activ,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cobalam/Lm-Folate/Py (Metanx),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coban,,,,, $10.32 , $10.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coban 4 Blue Roll 3m#1584b,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coccyx,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coenzyme Q10 100 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coenzyme Q10 150 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coenzyme Q10 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coenzyme Q10 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coenzyme Q10 60 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cogentin 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cogentin 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cogentin 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cogentin 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cogentin 2mg/2ml Amp,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cogentin1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colace 100mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colace 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colace Liquid 10 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colace Liquid 25 Cc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Col-Benemid,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colcace Liquid 5ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colchicine 0.6mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colcrys .6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cold Agglutinins Titer,,,,, $213.06 , $213.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cold Pack Disposable 6x9 24/S,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Cold Pack, Instant",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colesevelam (Welchol) 625mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colestid 1 Gram Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colestipol (Colestid) 1gm Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colestipol 1 Gm Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colestipol HCL 1gm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colistimethate (Colistin) 150m,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Collagenase (Santyl) Oint 15gm,,,,, $308.00 , $308.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Collar Cervical,,,,, $84.62 , $84.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colon Barium,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colon Barium W/Air,,,,, $536.00 , $536.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colon Clenz Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coloplast Clamps,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colostomy Bag 2 3/4 Quant-10,,,,, $27.15 , $27.15 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Colostomy Kit Drainable 4""",,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colostomy Pouch,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colostomy Pouch Ipc Convex,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Colostomy/Ileostomy Kit 5/Bx,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Comb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Combigan 0.2% /0.5,,,,, $621.00 , $621.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Combigan Eye Drops,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Combigan Liquid 5ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Combivent Inhaler 14.7gm,,,,, $430.00 , $430.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Combivent Respimat Inh,,,,," $1,335.00 "," $1,335.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Combivir Tablet,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Comm Work Reintegration/15min,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Commode Containers,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Comp Metabolic Panel,,,,, $684.76 , $684.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Compazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Complement Antigen,,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Complement C1 Function,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Complement C3 Antigen,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Complement C4 Antigen,,,,, $89.04 , $89.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Complement Total (Ch 50),,,,, $597.84 , $597.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Complete Spine Ap and Lat,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Complex + Msm,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Compound Benzoin Swabsticks,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Compound Dm 10/Quinidine 5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Compound Dm/Quinidine 20/10mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Compound Rx 30gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Comtan 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cone Finger Separater,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Conjugated Estrogen (Cenestin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Conjugated Estrogen (Premarin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Connecting Tube,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Connector 5-In-1,sterile",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Connector, 6-In-1 Y Sterile",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Connector,tubing,oxygen Supply",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Connector;bp Cuff Adaptor,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Connectors Omniflex - Medline,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Continuous Pulse Ox Setup,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Contrast Bath Per 15 Min,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Contrast Xray Uniary,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Control-A-Flo Tubing,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cooling Blanket,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Copaxone 20mg,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Copaxone 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Copper,,,,, $401.74 , $401.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coq-10 200 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cordarone 200mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coreg 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coreg 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coreg 3.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coreg 40 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coreg 6.25 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coreg Cr 20 Mg  Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Corgard 40mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Corge 12.5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Corona Ointment,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Correc Cr 40mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cortef 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cortisol 24hr Urine,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cortisol Am,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cortisol Pm,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cortisol Serum,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cortisone Acetate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cortisone1%/Lanacane/Mucurizol,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cortisporin Eye Drops 7.5 ML,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cosopt Eye Drops,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cosopt Eye Drops 2/0.5%,,,,, $436.00 , $436.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cosyntropin (Cortrosyn) Vl : .,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coumadin 1.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coumadin 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coumadin 2.5 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coumadin 3.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coumadin 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coumadin 6 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Coumadin 7.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cover Thermometer Probe Disp,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Cover, Probe",,,,, $76.32 , $76.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cozaar (Losartan)25 Mg /3,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cozaar 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cozaar 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cozaar 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPAP,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPAP Mask,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPAP/Bipap Per Day,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPAP/Bipap Setup,,,,, $798.00 , $798.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPK Isoenzymes,,,,, $412.34 , $412.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPK-Mb,,,,, $354.04 , $354.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cpr-Code Blue,,,,, $392.00 , $392.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPT Initial,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPT Subsequent,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPT W Percus/ Vibration Sub,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CPT W Percus/Vibration Initial,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cranberry Cap 450 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cranberry Extract 425 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,C-Reactive Protein Hs,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Creatine Kinase CPK Total,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Creatinine 24hr Urine,,,,, $214.12 , $214.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Creatinine Clearance,,,,, $286.20 , $286.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Creatinine Serum,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Creatinine Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Creatinine Urine Random,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CREON 12000 U,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CREON 6000 U,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Creon Dr 3000 U,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crestor 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crestor 20 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crestor 40 Mg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crestor 5 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cromolyn Sodium Opht Sol : 20m,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crossmatch Ahg/Unit,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crossmatch is,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crotalidae Polyvalen (Crofab),,,,," $7,094.00 "," $7,094.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crotamiton (Eurax) Lot : 0.1,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crp Ultrasensitive,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cryoglobulin,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cryptococcal Antigen,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cryptosporiduim Smear Stl,,,,, $252.28 , $252.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crystal Analysis,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Crystal ID Synovial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Abd W/Con,,,,," $2,140.14 "," $2,140.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Abd W/O Con,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Abd W/Wo Con,,,,," $3,997.26 "," $3,997.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Abdomen Ltd W/Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Abdomen Ltd W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Brain W/O Contrast,,,,," $1,682.22 "," $1,682.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Bx Abd/Retropperit Mass,,,,," $1,955.70 "," $1,955.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Cerv Spin Wo Cont,,,,," $7,418.00 "," $7,418.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Chest W/Con,,,,," $4,525.14 "," $4,525.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Chest W/O Contrast,,,,," $4,650.00 "," $4,650.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Chest W/Wo Contrast,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Chest W/Wo/Cont,,,,," $9,051.34 "," $9,051.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Coronal /Sag/Obloque,,,,," $1,108.76 "," $1,108.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Drb/Sell/Fossa/W/Contrast,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Facial W/O,,,,," $1,693.00 "," $1,693.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Guide Cyst Aspiration,,,,," $4,091.60 "," $4,091.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Guided Cyst Asp CPT,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Guided Needle Biopsy,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Guided Needle Bx CPT,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Guided Needle Loc,,,,," $2,268.40 "," $2,268.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Head W/Contrast,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Head W/O Contrast,,,,," $2,163.46 "," $2,163.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Head W/Wo Contrast,,,,," $1,966.30 "," $1,966.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Holograph /3d Reconst,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Iac W/O Cont,,,,," $3,239.36 "," $3,239.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Iac W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Lower Ext W/Contrast,,,,," $7,174.08 "," $7,174.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Lower Ext W/O Contrast,,,,, $842.70 , $842.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Lower Ext W/W/O Cont,,,,," $1,992.80 "," $1,992.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Ltd/Followup Study,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Lumbar W/Contrast,,,,," $3,739.68 "," $3,739.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Lumbar W/O Contrast,,,,," $3,963.34 "," $3,963.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Lumbar W/W/O Contrast,,,,," $4,854.80 "," $4,854.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Max-Fac Ltd W/O Contrast,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Maxillofacial W/O Contrast,,,,," $2,941.50 "," $2,941.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Neck W/Contrast,,,,," $2,894.86 "," $2,894.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Neck W/O Contrast,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Neck W/Wo Con,,,,," $5,556.52 "," $5,556.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Needle Bx,,,,," $3,383.52 "," $3,383.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Pelvis W/Con,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Pelvis W/Contrast,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Pelvis W/O Con,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Pelvis W/O Contrast,,,,," $2,019.30 "," $2,019.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Pelvis W/W/O Contrast,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Pelvis W/Wo Con,,,,," $4,118.10 "," $4,118.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Scan Arm/Shoulder,,,,," $2,254.00 "," $2,254.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Thoracent W/Tube Insert,,,,," $1,442.66 "," $1,442.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Thorax W/Contrast,,,,," $2,595.94 "," $2,595.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Thorax W/O Contrast,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Thorax W/W/O Contrast,,,,," $1,507.32 "," $1,507.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Thorax Wtd W/O Contr,,,,," $2,307.62 "," $2,307.62 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Upper Ext W/W/O Cont,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Upper Extrem W/Cont,,,,," $3,561.60 "," $3,561.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CT Upper Extrem W/O Cont,,,,," $3,587.04 "," $3,587.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cta Head W/&w/O Contrast,,,,," $3,922.00 "," $3,922.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cufflator Endo Tube Inflator,,,,, $259.70 , $259.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cult Fungi Other,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cult Grp B Strep,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Anaerobic,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Blood,,,,, $84.80 , $84.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Body Fluid,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Cath Tip,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Chlamydia,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Csf,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Fungus (Blood),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Fungus (Skin),,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Gc Definitive,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Genital,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Herpes ID Tiss Cult,,,,, $311.64 , $311.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Herpes Typing,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Non Urine ID,,,,, $81.62 , $81.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Sputum,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Stool Routine,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Tb/Afb Iso Only,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Throat,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Throat or Nose,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Urine,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Urine ID,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Viral,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Culture Wound Aerobic,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cup Denture Mauve 1/Ea,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cup Denture W/Lid 250/Cs,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cup Medicine,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cup Souffle Paper 1/2 Oz,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Curad Petrolalum Dressing,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cushion Gel Foam Redistribute,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cushion Pressure Redistributi,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cvl Dressing Change Kit W/O Bi,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyanide,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyanocobalamin (Vit B12) 1000m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyanocobalamin (Vit B12) 100mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyanocobalamin 500 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclobenzaprine (Flexeril) 10m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclobenzaprine 10 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclobenzaprine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclobenzarine HCL,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclopentolate Gtt 1% 15 ML,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclopentolate HCL (Cyclogyl),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclophosphamide (Cytoxan) Vl,,,,, $151.00 , $151.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclophosphamide 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclophosphamide(OP) (Cytoxan),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclosporine (Neoral) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclosporine (Restasis)  0.05%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclosporine (Sandimmune) Sol,,,,," $1,566.00 "," $1,566.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclosporine Level,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyclosporine Opth 0.4%,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cymbalta 20mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cymbalta 30mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cymbalta 60 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyproheptadine (Periactin) 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyproheptadine 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyproheptadine Liq : 2mg/5ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,CYPROHEPTADINE SYR 110ML BTL,,,,, $59.08 , $59.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cysticepsosis by Elisa,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cystine Urine 24hr,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cysto Min 3 Views S&i,,,,, $753.00 , $753.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cystogram S&i,,,,, $471.00 , $471.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cyto Non Gyn Smear Interp,,,,, $149.46 , $149.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytology Cell Block,,,,, $281.96 , $281.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytology Non-Gyn Con Tech,,,,, $173.84 , $173.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytomegald Igg,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytomel 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytopath Ext Study>5 Slides,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytopath Non-Gyn Prep/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytopath Oth Sourc/Screen,,,,, $172.78 , $172.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytopathology Sce W/Interpret,,,,, $532.00 , $532.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytotec 100 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytotec 200 Mcg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Cytra K 5ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D Dimer,,,,, $517.28 , $517.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D10 W,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D50w 50ml Injection,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D5ns/Kcl 20meq 1000mls,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D5w 0.45ns Bag 1000ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D5w 1/2ns Kcl 20meq 1000ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D5w 1/4ns Kcl 20meq 1000ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D5w/Lr 1000ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D5w/Ns 1000ml Bag,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dakins 25% 473 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Daliresp 500 Mcg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dalteparin (Fragmin) 10000 Uni,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dalteparin (Fragmin) 12500 Uni,,,,, $452.00 , $452.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dalteparin (Fragmin) 2500 Unit,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dalteparin (Fragmin) 5000 Unit,,,,, $185.00 , $185.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Danazol Cap : 200mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dantrolene (Dantrium) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dantrolene Sodium,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dapsone 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Daptomycin (Cubicin) 500mg Inj,,,,," $1,214.00 "," $1,214.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Daptomycin (Cubicin) Vl : 500m,,,,," $1,057.00 "," $1,057.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Daptomycin (OP) (Cubicin) Vl :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darbepoetin (Aranesp) 60mcg In,,,,," $1,850.00 "," $1,850.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darbepoetin (Aranesp) Inj 0.1m,,,,," $1,451.00 "," $1,451.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darbepoetin Alfa (Aranesp 200m,,,,," $5,808.00 "," $5,808.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darbepoetin Alfa (Aranesp 25mc,,,,, $727.00 , $727.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darbepoetin Alfa (OP) (Aranesp,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darbepoetin Alfa/Alb (Aranesp,,,,," $1,162.00 "," $1,162.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darifenacin (Enablex) Tab : 15,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darifenacin (Enablex) Tab : 7.,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darvocet 50/325 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darvocet N 100mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darvocet N 50 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Darvon 65mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D-Dimer Quantitative,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debride Nails Any Meth >6,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debride Nails Any Meth 1-5,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debride Skin Full,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debride Skin Partial,,,,, $351.92 , $351.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debride Skin/Subq Tiss/Musc,,,,, $652.96 , $652.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debride Skin/Subq Tissue,,,,, $620.10 , $620.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debride Skin/Subq/Musc/Bone,,,,," $1,240.20 "," $1,240.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debridement Tray Gss,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debrox Sol Ear Drops,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debrox Solution 6.5% (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Debrox Solution 6.5% (drop),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Decadron 10.5mg-Vibratabs 25ml,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Decadron 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Decalcification Procedure,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Decannulation Plug,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Declomycin 150 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Del Clamp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Delsym 12hr Cough Sup 30mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Delsym 3.33 ML Per Dose=20 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Delsym 89 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Delsym Each Tsp,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Deltasone 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Demadex Non-Frm 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Demeclcycline 300 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DEMECLOCYCLINE 300 MG,,,,, $33.20 , $33.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Demeclocycline HCL (Declomycin,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dentips Oral Swabsticks,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Denture Adhesive,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Denture Brush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Denture Cleaning Tablet,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Denture Cup,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Deodorant,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Deodorant Roll On Unscent,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene 250 Mg/5ml,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elix 140 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 100 ML Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 105 ML,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 160 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 175 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 200 ML Bottle,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 210ml,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 473 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 480 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 50 ML Bottle,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 80 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Elixir 90 ML Bottle,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Liquid 120 ML Bottle,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakene Liquid 30 Cc Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote 1000 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote 125 Mg Cap,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote 125 Mg Sprinkles,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote 1500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote 250 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote 250mg/5ml  S 140ml,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote 750 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depakote Sprinkles 250 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Deplin 15 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Deplin 7.5 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depo Provera,,,,, $729.00 , $729.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DEPO TESTOSTERONE 200MG/1ML VI,,,,, $113.96 , $113.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depomedrol 80 Mg,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Depo-Medrol 80 Mg Im,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dermal Wound Cleaner 1 Bottle,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dermal Wound Cleanser,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Descovy 200 25 mg,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desipramine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desipramine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desipramine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desloratadine 5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desmopressin 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desmopressin Acet (Ddavp) Amp,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desmopressin Acet (Ddavp) Mdv,,,,, $758.00 , $758.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desmopressin Acetate (Ddavp) T,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desmopressin Acetate 0.1 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desmopression 0.2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desoc/Nizc/Mom Compound,,,,, $651.00 , $651.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Deson/Ketox/Mom Cream,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desonide Lot 0.05,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Destroxe 70% 500ml,,,,, $236.00 , $236.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DESVENLAFAXINE ER 50 MG,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Desyrel 100mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Detrol La 2 Mg Tab,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Detrol La 4 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexamethasone 1 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexamethasone 1.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DEXAMETHASONE 2 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexamethasone 4mg Vial,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexamethasone 4mg/ML 5ml Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexamethasone Oral Sol : .1mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexamethasone Tab : 0.75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexamethasone Tab : 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexamrth 1mg/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexilant 30 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dexilant 60 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextran-40/D5w 10% Inj,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DEXTROAMPHETAMIN 30 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 10% 1000mls,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 20% 500ml,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 5% (D5w) 500ml Inj,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 5% 0.2%nacl Bag : 1ml,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 5% 1000ml Inj : 1ml,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 5% 100ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 5% 250ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 5% 50ml Ivpb,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 5% Lac Ring Sol : 1ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 50% 500ml Bag,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 50% Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 50% Syringe 50ml,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose 70% 1000ml Bag,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dextrose Amp : 0.1,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dhea S Serum,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diabeta 2.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diabeta 5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diag Bronch,,,,," $1,286.00 "," $1,286.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dialysis Pd 2 1.5 6000ml,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dialysis Pd 2 2.5 6000ml,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dialysis Sol 1.5,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diamox 250 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diary Digest,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diatx Tab 1,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazapam 10mg Inj,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam (Valium) 10mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam (Valium) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam (Valium) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DIAZEPAM .05 MG,,,,, $1.76 , $1.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diazepam Assay,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diclofenac (Voltaren) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diclofenac 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diclofenac Pot Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diclofenac Sod,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DICLOFENAC SOD 1% GEL,,,,, $199.00 , $199.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DICLOFENAC SOD 50 MG,,,,, $3.12 , $3.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diclofenac Sodium (Voltaren) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diclofenac Sodium/Misoprostol,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dicyclomine (Bentyl) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dicyclomine (Bentyl) 2mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dicyclomine (Bentyl) Inj : 10m,,,,, $227.00 , $227.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dicyclomine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dicyclomine HCL 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diff-Stat Chew Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diflorasone Diacetate Crm,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diflucan 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diflucan 150 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diflucan 200 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diflucan 50 Mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diflunisal Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digital Termometer,,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin (Lanoxicaps) Cap : 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin (Lanoxin) 0.125mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin (Lanoxin) 0.25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin (Lanoxin) 0.5mg/2ml Am,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin 0.1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin 0.25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin 250mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin Elx : 0.05mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin Immume Fab (Digifab) S,,,,," $1,568.00 "," $1,568.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Digoxin Lab,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dil Nephrostomy Tract,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilacor Xr 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin 125 Mg/5ml 1 Btl Stoc,,,,, $243.00 , $243.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin 200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DILANTIN 30 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin 400 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin 50mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin Elixir 240 Cc Bottle,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin Elixir 60 ML Bottle,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin Elixir 80 ML Bottle,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin Liquid 170 Cc Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin Liquid 224cc Bottle,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin Liquid 70 Cc Bottle,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin Liquid 85 ML Bottle,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilantin Liquid 90 Cc Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilaudid 4 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dilaudid 8 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem (Cardizem Cd) 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem (Cardizem Cd) 240mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem (Cardizem) 100mg Inj,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem (Cardizem) 125mg/25m,,,,, $588.00 , $588.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem (Cardizem) 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem 180,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem 360 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem Cd 120mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem Cd 180mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem Cd 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem Cd 300mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem ER 120,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem ER 300mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem HCL 30mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem HCL 60 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem HCL Cd (Cardizem) Ca,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem HCL ER 240mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem HCL Sa 24h 120,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem HCL Sa 24hr 180,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diltiazem HCL Sdv : 5mg,,,,, $523.00 , $523.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dimeric Inhibin A,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan (Hct) 80/12.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan 160 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan 160/25 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan 320 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan 320/25 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan Hct 80/12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan Hctz 160/12.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diovan(Valsartan)160mg Tab,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dipentum Cap : 250mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphedryl Sod,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenhist 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenhist Elixer Rugby,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenhydramine (Benadryl) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenhydramine (Benadryl) 50m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenhydramine (Benadryl) Cre,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenhydramine 25 (Rug),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenhydramine 50(Rug),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenhydramine(Benadryl) 12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenoxyl/Atropine,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenoxylate/Atrop S 2.5,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenoxylate/Atrop S1e,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diphenoxylate/Atropine (Lomoti,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dipyridamole 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dipyridamole 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dipyridamole Inj : 5mg/ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dipyridamole Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Direct Coombs,,,,, $137.80 , $137.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Directogen Serum,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Diskographylumbar S&i,,,,," $1,339.84 "," $1,339.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Disopyramide Sa (Norpace Gen.),,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Disp Personal Safe Limb Holder,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dispo-A-Probe,,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Disposable Headstrap,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Disposable Lead Wires,,,,, $261.82 , $261.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dispoz-A-Bag Leg Bag,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Distilled Water,,,,, $11.19 , $11.19 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DISULFIRAM 250 MG,,,,, $9.24 , $9.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ditropan 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ditropan 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ditropan 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ditropan Xl 5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex (Depakote ER) 500mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex (Depakote) 250mg Ta,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex Dr 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex Dr 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex ER 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex ER 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex Sod 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex Sod 500 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex Sod Dr 25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex Sod ER 50,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex Spr 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex Spr 125 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divalproex(Depakote Sprinkles),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Divan 40mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D-Meth/P-Ephed/Bromp (Cardec),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D-Meth/Phenyleph/Cpm (Atuss Dm,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D-Methorph/P-Ephed-C (Cardec),,,,, $215.00 , $215.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dna Antibody Single,,,,, $298.92 , $298.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dobutamine (Dobutrex) 250mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dobutamine 250mg/D5w 250ml Ivp,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Docetaxel (80mg/2ml) (Taxotere,,,,," $8,438.00 "," $8,438.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Docosaheanoic Acid (Fish Oil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Docusate (Colace) 100mg/10ml L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Docusate (Enemeez) 283mg Enema,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Docusate Calcium,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Docusate Calcium (Surfak) 240m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Docusate Calcium 240,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Docusate Sodium 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DOCUSATE SODIUM 240 ML BOTTLE,,,,, $28.28 , $28.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dolasetron (Anzemet) 12.5mg/0.,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Donepezil (Aricept) 5mg Tab,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Donepezil HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Donepezil HCL 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DONEPEZIL HCL 23 MG,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Donepezil HCL 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Donnatel/Maalox,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dopamine 400mg (40mg/ML) Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dopamine/D5w 400mg Drip 250ml,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doppler Sngl Lvl Ext Art Bil,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dorapenem (Doribax) 500mg Vl,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dorzolamide (Trusopt) Eye Drop,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dorzolamide Eye Drops,,,,, $121.00 , $121.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dorzolamide HCL 2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dorzolamide/Timolol (Cosopt) E,,,,, $336.00 , $336.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dorzolamide-Timolol,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxazosin (Cardura) 4mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxazosin 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxazosin 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxazosin 6 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxazosin 8 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxazosin Mesylate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxazosin Mesylate 1mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxazosin Mesylate 4mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin (Sinequan),,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin (Sinequan) 25mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin 75 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin HCL 25mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxepin HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxercalciferol (Hectoral) Amp,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxercalciferol (Hectorol) 0.5,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxetaxel(20mg/.5ml) (Taxotere,,,,," $2,109.00 "," $2,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxycycline (Vibramycin) 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxycycline 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxycycline 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxycycline Hyclate 100m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxycycline Hyclate Vl : 100mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Doxycycline Monohydr (Vibramyc,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drain Chest 2 Pat Tubes Ster,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drain Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drain Safety 2 Pat Tubes Ster,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drain Sponge 4x4 Sterile,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Drain Suct Probe Tube 9"" Closd",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Drain,chest, 2 Patient Tube ST",,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Drain,safety,closed Suct H20 T",,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Drain,suction Probe 9' Tube Cl",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Drain,suction Probe 9tube Clsd",,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Change Charge,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Clr-Acrylic Tegaderm,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Gauze Stretch 2x2yd,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Silverfoam Medium,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Tegaderm Small,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Telfa Island Adhesi,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Transparent Frame 6x8,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing Wnd Mepilex-Lite 6x6,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Dressing, Acticoat 16x16",,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Dressing, Tubular Net Sz 9",,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dressing; Promogran Matrix 4.3,,,,, $58.30 , $58.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dronabinol (Marinol) 2.5mg Cap,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dronedarone 400 Mg,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Droperidol 2.5 Mg/ML 20,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drotrecogin (Xigris) Vl : 20mg,,,,," $6,604.00 "," $6,604.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drotrecogin (Xigris) Vl : 5mg,,,,," $1,651.00 "," $1,651.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drug Screen Urine,,,,, $619.04 , $619.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drug Screen With Alcohol,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Drug Screen:confirmation,,,,, $196.10 , $196.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DRYSOL DABOMATIC CRM 60CC,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dsdna Auto Ab's,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dss 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dss W/Casan,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Du Typing Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DUEXIS 800 26.6 MG,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dulcolax,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dulcolax 10 Mg Supp,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dulcolax 15 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dulcolax 5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duleek Met,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dulera Inhaler,,,,," $1,241.00 "," $1,241.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duloxetine (Cymbalta) 20mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duloxetine (Cymbalta) 30mg Cap,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duloxetine 30mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DULOXETINE HCL DR 20 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duloxetine HCL Dr 60 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duoderm Dressing,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duoneb 2.5,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duoneb 3ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duoneb Albut3mg/Iprat.5mg Vial,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duovisc Sol : 0.5/0.55,,,,, $954.00 , $954.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duplex Esterm Veins Cmp Bilat,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duplex Extracran Art Uni/Lmt,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duplex Lower Arteries Cmp,,,,," $4,011.04 "," $4,011.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duplex Lower Arteries Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duplex Upp Extrem Art Ltd,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duragesic 50 Mcg/Hr 5's,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Duragesic Patch 25 Mcg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DUREZOL OPTH EMULSN 0.05%,,,,, $728.00 , $728.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dutasteride (Avodart) 0.5mg Ca,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,D-Xylose,,,,, $526.82 , $526.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dyazide,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dyazide 37.5/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dycem Matting,,,,," $1,064.24 "," $1,064.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,DYMISTA NASAL SPRAY 23 GM,,,,, $816.00 , $816.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dynacirc Cr 10 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dynacirc Cr 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dynacirc Cr 5mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dynapen 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dyno Pro Flex Knee,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dyphylline/Guaifenes (Panfil G,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Dytan 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,E Cylinders,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,E E S Granules 100 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eakin Wound Pouch & Fistula,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ear Protector E-Z Wrap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ear Wax Drps,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Easy Cap Ii Co2 Detector,,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Echo 2d&m Complete,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Echo Cardiogram,,,,," $4,562.00 "," $4,562.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Echo Color Doppler,,,,, $703.84 , $703.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Echo D&m Limited,,,,, $378.42 , $378.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Echo Doppler Follow-Up Pr Ltd,,,,, $489.72 , $489.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Echo Routine,,,,, $768.50 , $768.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Echograhy Transrectal,,,,, $858.60 , $858.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eclipse Injection Needle,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Econazole Nitrate 1% Cream,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Edecrin 25mg Tab(Ethacrynic Ac,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Edema Gloves 1ea,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Edrophonium Chloride (Enlon) I,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Educational 60 Mi,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EEG,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EEG Awake/Drowsy,,,,," $1,215.82 "," $1,215.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EEG Monitoring Up to 1 Hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EEG Monitoring> 1hr,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EEG Routine Awake/Sleep,,,,," $1,196.74 "," $1,196.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EEG Sleep Only,,,,," $1,587.88 "," $1,587.88 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EEG-Nonintractran Surg 0-24hr,,,,," $1,988.56 "," $1,988.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ees Filmtb 400 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Efavirenz (Sustiva) 600mg Tab,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Efferdent(Denture Cleaner Tab),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Effervesent Klor Con 20 Meq Pk,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Effexor 225 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Effexor 37.5 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Effexor 50 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Effexor Xr 150mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Effexor Xr 75 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Effient 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Egg Crate/Mattress Pad,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ehrlichia Titer,,,,, $217.30 , $217.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EKG,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EKG Rhythm Strip,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elavil 100 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elavil 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elbow 2v Comp,,,,, $309.52 , $309.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elbow Ap & Lat,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elbow Complete,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elbow Complete I/F,,,,, $337.00 , $337.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elbow Min 3v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eldertonic Elixir 105 Cc Bottl,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electrocardiogram,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electrode Defib Fm 20s,,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electrode Ecg Foam 30pk 6000cs,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electrode Pad Pac Quick Com R,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electrode Tab 100/Pk G55,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Electrode, Ecg 30 Pack",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electroholresis-Serum,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electrolyte Panel,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electrolytes (Tpn Electrolytes,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Electrophoresis (Fap Test),,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elestat 0.05% Eye Drops,,,,, $506.00 , $506.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eletriptan Hydrobrom (Relpax),,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elidel 1% 60 Gr Cream,,,,, $235.00 , $235.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elidel 1% Cream 30 Gram,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elimite Cream 5%,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eliquis 2.5 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eliquis 2.5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eliquis 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eliquis 5 MG Tab. (Apixaban),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elmiron 100,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Elnorm 6mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Embol Extracranial CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Embolization CPT,,,,," $4,369.32 "," $4,369.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Embolization Therapy,,,,," $8,848.00 "," $8,848.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Embolization Therapy S&i,,,,," $5,008.00 "," $5,008.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Emery Board,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Emesis Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,EMG Electromyograph,,,,, $960.00 , $960.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Empty Glass Vl : 500ml,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Emsam Patch 6 Mg,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Emtricitabine/Tenofovir (Truva,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enablex 15mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enablex 7.5 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril (Vasotec) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril (Vasotec) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril 10/Hctz 25 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril Maleate,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril Maleate 10,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril Maleate 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalapril Maleate 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enalaprilat (Vasotec) 1.25mg I,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Encephalitis East Equine,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Encephalitis ST Louis,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endal Hd Syr 10ml,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endo Bile/Pancreas Duct S&i,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endo Trachael Size 7.5,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endocet 10/325 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endocet 10/650 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endocet 2.5/162.50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endocet 5/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endocet 7.5/500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endotrach Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Endotracheal Tube 8.0,,,,, $4.24 , $4.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enema Bag With Soap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enoxaparin (Lovenox) 100mg Inj,,,,, $446.00 , $446.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enoxaparin (Lovenox) 30mg Inj,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enoxaparin (Lovenox) 40mg Inj,,,,, $178.00 , $178.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enoxaparin (Lovenox) 80mg Inj,,,,, $357.00 , $357.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enoxaparin 0.3mg Inj,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enoxaparin 100mg,,,,, $583.00 , $583.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ENOXAPARIN 80 MG SYR,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enoxaparin Sod 40 Mg Syringe,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enoxaparin Sod 60mg Syr,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ensure,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ensure Chocolate 8oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ensure Shake,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Entacapone (Comtan) Tab : 200m,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Entacapone 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Entacort .25 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enteral Feeding Kit,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enteral Irrigation Kit,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enteral Nutritional Pump,,,,, $822.00 , $822.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enterg(Alvimopan)12mg Cap,,,,, $145.00 , $145.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enteric Coated Aspirin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ENTRESTO 24-26 MG,,,,, $34.28 , $34.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Enzymatic Digestion,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eosinophil Count,,,,, $181.26 , $181.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eosinophils Nasal Smear,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eosinphhil Count,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ephedrine 50mg Inj,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epidrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epidural Steroid Injection CPT,,,,, $392.20 , $392.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epinastine Opt 1 Drp,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epinephrine 1mg Syringe,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epinephrine 1mg/ML 30ml Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epirubicin HCL (Ellence) Vl :,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eplerenone 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eplerenone 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin 20000 OP (Procrit) Vl,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin Alfa,,,,," $4,247.00 "," $4,247.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin Alfa (Epogen) Vl : 200,,,,," $1,669.00 "," $1,669.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin Alfa (Procrit Ip) Vl :,,,,," $1,591.00 "," $1,591.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin Alfa (Procrit) 10000 U,,,,, $921.00 , $921.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin Alfa (Procrit) 40000 U,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin Alfa(10000) (Epogen (O,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin Alfa(10000) (Epogen) V,,,,, $776.00 , $776.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epoetin Alfa(20000) (Epogen (O,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epogen 1000 Units,,,,, $904.00 , $904.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epogen 10000 Unit/1ml,,,,, $614.00 , $614.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Epogen 14,000 Units",,,,," $3,354.00 "," $3,354.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Epogen 20,000 Units",,,,," $1,408.00 "," $1,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epogen 20000 Units/1ml,,,,," $1,225.00 "," $1,225.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epogen 4000 Units/1ml,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eprosartan Mesylate (Teveten),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epstein Barr (Ea),,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epstein Barr Ea,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epstein Barr Ebna,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epstein Barr Vca,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epstein Barr Vca Igg,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epstein Barr Vca Igm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Epstein-Barr Viral Cap Igg,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eptifibatide (Ip) (Integrilin),,,,, $512.00 , $512.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eptifibatide Ip (Integrilin) V,,,,," $1,602.00 "," $1,602.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eptifibatide OP 100m (Integril,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eptifibatide OP 10ml (Integril,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Era,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ercp Biliry Duct,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ercp Pancreatic Duct S&i,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ercp Radiology CPT,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Ergocalciferol 50,000",,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ergocalciferol 50000 Units (Vi,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ertapenem (Invanz) 1gm Vial,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eryped 200mg/5ml,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythrocin 250 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythromycin (Base) E Tab : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythromycin 0.5% Opth Oint,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ERYTHROMYCIN 250 MG,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythromycin 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythromycin 500mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythromycin Base OP Oint 5mg,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythromycin Es (Eryped) Sus :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythromycin Es C (Eryped) Sus,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Erythropoietin,,,,, $848.00 , $848.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Escitalopram (Lexapro) 10mg Ta,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Escitalopram 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Escitalopram 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Escitalopram 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Esidrix 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eskalith Cr,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Esmolol HCL Sdv : 10mg,,,,," $1,201.00 "," $1,201.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ESOMEPRAZOLE DR 20 MG,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Esomeprazole Dr 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Esoph With Video,,,,, $890.40 , $890.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Esophagus,,,,, $557.56 , $557.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estazolam 1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estrace Vaginal Crm 0.1%,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol (Alora) 0.05mg Patch,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol (Climara) 0.1mg Patc,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol 0.0375 Mg Patch,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol 0.075 Mg Patch,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol 0.1% (treatment),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol 0.1% Cream (tube),,,,, $291.18 , $291.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol 2mg Tablet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol Acetate (Femtrace) T,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol Patch .025 Mg,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol Patch 0.05 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol Serum,,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estradiol Tdwk 0.05mg Patch,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estriol Unconjugate,,,,, $263.94 , $263.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estrogen Level,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estrogen Total,,,,, $694.30 , $694.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estrogens Conjuagted (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estrogens Conjugated (Premarin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estrogens Est/M-Test (Estrates,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estrogens Esterified (Menest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estrone,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estropipate (Ogen) 1.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estropipate 0.625,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estropipate 0.75mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estroven 1 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Estroven Weight Mgt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eszopiclone (Lunesta) Tab : 1m,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eszopiclone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eszopiclone 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eszopiclone 3 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eth0suximide,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ethambutol 400 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ethambutol HCL (Myambutol) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ethezme (Kovia) Oin,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ethylene Glycol,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Etodolac 100mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Etodolac 400 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ETODOLAC 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Etodolac 600 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Etodolac Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Etodolac Xl Tab : 400mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Etomidate (Amidate) Amp 2mg/ML,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Etoposide Vl : 10mg,,,,, $490.00 , $490.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ett Trach Holder - Medline,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eucerin Repair Cream 4oz,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eucerine Cream 57 Gm Tube,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Evacuated Container Bot : 1000,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eval Swallow Function Fees,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,E-Vista 60 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Evoxac 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exelon 1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exelon 3mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exelon 4.5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exelon 4.6 /24hr P 30,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exelon 6 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exelon Patch 13.3 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exelon Patch 4.6 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exelon Patch 9.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exemestane (Aromasin) Tab : 25,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exenatide (Byetta) Pen : 10mcg,,,,," $1,195.00 "," $1,195.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exforge 10/160/25 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exforge 10/320 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exforge 5 320mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Exforge 5/160 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ex-Lax,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Expiratory Filter,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ext Venous Stdy Unilat/Limited,,,,, $719.00 , $719.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Extension Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Extractable Nucl Antigen Ss-A,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eye for Fb,,,,, $387.96 , $387.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Eye Stream 30ml,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ezetimibe (Zetia) 10mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ez-Pap W/Manometer,,,,, $116.60 , $116.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Facial Bone 3 Views,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Facial Bones Comp,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Facial Bones Min 1-2 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor 8 Level,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor Ii Prothrombin,,,,," $1,073.78 "," $1,073.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor Ix Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor V Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor V Leiden Mutation,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor Viii Clot:antigen,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor Viii Ristocetin Cofact,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor X Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor Xi Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor Xii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Factor Xiii Clotting,,,,," $1,137.38 "," $1,137.38 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Famciclovir (Famvir) 250mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Famotidine (Pepcid) 20mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Famotidine (Pepcid) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Famotidine 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FAMOTIDINE 40 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fanapt 1 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fanapt 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fanapt 4 Mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FARXIGA 10 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FE C TAB 100,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feb Agglu Ox-19,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feb Agglut Ea,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feb Agglut Papa A,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feb Agglut Paratyphoid B,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feb Agglut Typh D,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feb Agglut Typh H,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Febrile Agglut Each,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Febuxostat (Uloric) 40mg Tab,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fecal Fat,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fecal Fat Quant,,,,, $539.54 , $539.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fecal Fat Screen,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fecal Leukocytes Smear,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fecal Mngmnt Sys Flexi-Seal,,,,," $2,764.48 "," $2,764.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feeding Set,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Felbamate (Felbatol) Tab : 600,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Felcainide 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feldene 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Felodipine (Plendil) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Felodipine (Plendil) Tab : 2.5,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Felodipine 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Felodipine ER 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Felodipine ER Tab 10 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Femara 2.5 Mg Tab,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Femera 25mg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Femur,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Femur Min 2views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fenofibrate (Tricor) 145mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fenofibrate 134 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fenofibrate 145mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FENOFIBRATE 160 MG,,,,, $4.64 , $4.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fenofibrate 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fenofibrate 48 Mg Tab,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FENOFIBRIC ACID 135 MG,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fenofibric Acid 45 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fenoldopam Mesylate (Corlopam),,,,," $1,113.00 "," $1,113.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl (Duragesic) 100mcg Pa,,,,, $280.00 , $280.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl (Duragesic) 12mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl (Duragesic) 25mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl (Duragesic) 50mcg Pat,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl (Duragesic) 75mcg Pat,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl 100mcg Amp 2ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl 75mcg/Hr Pathc,,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl Citrate 5ml Amp : 0.0,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl Patch 100 Mcg,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl Patch 12 Mcg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl Patch 25 Mcg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FENTANYL PATCH 37.5 MCG,,,,, $202.60 , $202.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl Patch 50 Mcg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl Transdermal 25mg,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fentanyl Transdermal 50m,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feogen Ga,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Feosol,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fergon,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fergon 27 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fergon 324 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrex 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferritin,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferro Sulf 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Fum/Vitc/B12/If (Foltr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Fumarate Cap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Gluconate (Fergon) 300,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FERROUS GLUCONATE 324 MG,,,,, $1.48 , $1.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Gluconate 325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sul 120 ML Bottle,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sul 140 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sul 210 ML Bottle,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sul 290 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sul 30 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sul 50 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Ferrous Sulf 7.5ml=1,1/2 Tsp",,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FERROUS SULF ELX 100 ML BOTTLE,,,,, $21.96 , $21.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sulfate (Slow-Fe) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sulfate 1 Tsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sulfate 160,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sulfate 300mg/5ml Elix,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sulfate 325mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ferrous Sulfate 8.8 Mg El,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FETZIMA 40 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FETZIMA 80 MG,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FETZIMA ER 20 MG CAPSULE,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fexofenadine 180 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fexofenadine HCL,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fiber Laxative 625,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fiber Powder,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fibercon 500mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fibercon 625 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fibracol Plus Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fibren Split Product,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fibrinogen Activity,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fibrinogen Quan,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Filgrastim (Neupogen) 300mcg I,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Filgrastim (Neupogen) 480mcg V,,,,," $1,268.00 "," $1,268.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Film Copy X-Ray,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Finasteride (Proscar) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Finasteride 5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Finasteride 5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Finger 2 Views Min I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fingers,,,,, $198.00 , $198.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fioricet 1 Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fioricet Comb Drug No Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fiorinal/Cod #3,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fish Oil 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fish Oil 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fish Oil Mineral 1000 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fish Oil Mineral 1760 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fistula & Wnd Mangmnt System,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fixodent Free Dent Crm 1.4 Oz,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flagyl 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flagyl 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flanders Butt Oin,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flavoxate (Urispas) Tab : 100m,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flavoxate 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flax Seed Oil 1000 Mg Softgel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flecainide 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flecainide Acetate Tab : 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flector 1.3% Patch,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fleet Prep Kit #3,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fleets Enema,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fleets Phospho-Soda 3oz.,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flexeril 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flexeril 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flexiseal Bag,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flexiseal Management System,,,,," $2,640.46 "," $2,640.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flextra 650(Acetam/Phenytolax),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flomax 0.4 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flonase Nasal Spray,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Florajen Acidophilus,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Florajen Acidophilus Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Floranex Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Florastor 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Florinef 0.05 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Florinef 0.1 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Florinef 0.2 Fludrocortisone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Florinef 0.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Florinef Fludrocortisone Aceta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flouro Less Than 1 Hour,,,,, $446.26 , $446.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flouro Local Bx/Aspir X&i,,,,," $1,691.00 "," $1,691.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flouro More 1 Hour,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flouro Needle Placement S&i,,,,," $1,154.34 "," $1,154.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flouromethodone Eye Drop 1 Btl,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flovent 220 Mcg Inhaler,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flovent 44 Mcg Inhaler,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flovent Hfa,,,,," $1,507.00 "," $1,507.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flovent Hfa 100 Mcg,,,,, $230.00 , $230.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flow Cytometry,,,,, $577.70 , $577.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flow Cytometry Dna,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flow Cytometry Ea Cell Marker,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flow Cytometry Tech Ea Add,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flow Cytometry Tech Initial,,,,, $153.70 , $153.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flu Vaccine,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flu Vaccube .05 ML,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluconazole (Diflucan) 100mg T,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluconazole (Diflucan) 200mg I,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluconazole (Diflucan) 400mg I,,,,, $168.00 , $168.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluconazole 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluconazole 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluconazole 150mg(Diflucan),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FLUCONAZOLE 200 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flucytosine (Ancobon) 500mg Ca,,,,, $130.00 , $130.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fludarabine Phosphat Vl : 50mg,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fludrocorisone 0.1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fludrocortisone (Florinef) 0.1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fludrocortisone 0.1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fludrocortisone Ace,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flumazenil (Romazicon) 0.5mg I,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flunisolide (Aerobid) Inhaler,,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flunisolide 0.025 Mg Spray,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluocinolone .01% 60,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluocinolone Acetonid Sol : 0.,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluocinonide (Lidex) 0.05% Cre,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluocinonide 0.05% 30gm Tube,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluocinonide Crm : 0.0005,,,,, $426.00 , $426.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoprazine 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluor Guid Cath or Inject,,,,," $1,066.00 "," $1,066.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluorescein O/S : 0.25/0.4,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluorescein Sod (Fluor-I-Stri),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoro Gde Vertpasty Ea Vert,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoro Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoro Pacemaker Insert,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoro W/O Film,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluorometholone 0.1%,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluorometholone 5 ML Bottle 1%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine (Prozac),,,,, $681.58 , $681.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine (Prozac) 10mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine (Prozac) 20mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine 20 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine HCL (Prozac Wkly) C,,,,, $148.00 , $148.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine HCL 20mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluoxetine HCL Liq : 4mg,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluphenazine (Prolixin) 5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluphenazine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluphenazine 25 Mg/1 ML,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluphenazine 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluphenazine 5 ML Vial,,,,, $625.00 , $625.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluphenazine 50 Mg/ 2 ML,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluphenazine Dec 25m,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluphenazine Dec Epipen,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flurazepam,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flurazepam (Dalmane) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flurazepam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flurbiprofen (Ansaid Gen.) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flurbiprofen Sod O/S (Ocufen G,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flurbiprofen Sod Solution,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flurbriprofen 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluromethalone (Fml)0.1% 5ml E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flutamide (Eulexin) Cap : 125m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Flutamide 125 Mg Cap,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluticasone (Flonase) Nasal In,,,,, $394.00 , $394.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluticasone (Flovent) 110mcg I,,,,, $653.00 , $653.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluticasone (Flovent) 220mcg I,,,,," $1,015.00 "," $1,015.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluticasone (Flovent) 44mcg In,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluticasone 50mcg,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluticasone Nasal Spray,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluticasone P Cr 15,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FLUTICASONE P CRM 0.05%,,,,, $81.66 , $81.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluvastatin (Lescol) Cap : 20m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluvastatin Sodium (Lescol Xl),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluvoxamine 100 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluvoxamine 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluvoxamine Laleate,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluvoxamine Mal ER 150 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fluzone,,,,, $237.00 , $237.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fna Evaluation,,,,, $204.58 , $204.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foam Dress W/Suction Bell Med,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folacin B/6/B12,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folamin Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FOLBEE PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folbee Vitiamn,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folbic,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foley Cath Silicone 20fr 30cc,,,,, $43.46 , $43.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foley Catherter Silicone Elas,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foley Catheter Silicone Elasto,,,,, $10.60 , $10.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folgard 2.2mg (Combgen) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folic Acid 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folic Acid 400 Mcg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folic Acid 5mg/ML Inj,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folic Acid 800 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folic Acid Rbc,,,,, $337.08 , $337.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Folic Acid, Serum",,,,, $419.76 , $419.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Folic Acid/B Comp W-C (Nephroc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foltanx 90 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foltrin Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foltx 1-2.5-25tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foltx Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fondaparinux (Arixtra) 2.5mg/0,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foot 2 Views,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foot Ap & Lat,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foot Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foot Complete 3 Views,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foot Complete I/F,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foot Min 3 Views,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foradil 12ud Inhaler,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Foradil Aerolizer 12mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Forceps, Adson",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Forceps, Mouse Tooth",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Forearm 1 Joint,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Forearm 2 Views,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Forearm 2 Views I/F,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Formoterol (Foradil) Inh Pwder,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fortaz 1 Gram Vial,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Forteo 20 Mcg Inj Each,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fortical Nasal Spray,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fortical Nasal Spray 200 Units,,,,, $284.00 , $284.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fosamax 70 Mg,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fosinopril (Monopril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fosinopril 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fosinopril 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fosinopril 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fosinopril/Hctz,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fosphenytoin (Cerebyx) 100mg I,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fosphenytoin (Cerebyx) 50mg In,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fresh Frozen Plasma,,,,, $373.12 , $373.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fresh Frozen Plasma Processing,,,,, $98.58 , $98.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Freshkote Eye Drps,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Frozen Blood Prep Freeae/Thaw,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Frozen Blood Preparation,,,,, $138.86 , $138.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Frozen Blood W/Thawing,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Frozen Section Addl Tissue Blk,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Frozen Section Single Specimen,,,,, $638.12 , $638.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FSH Follicle Stim-Ho,,,,, $607.38 , $607.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fta-Abs,,,,, $287.26 , $287.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Full Face Mask Large,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Full Face Mask Medium,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Full Face Mask Small,,,,, $78.44 , $78.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fulvestrant (Faslodex) Syg : 2,,,,, $513.00 , $513.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fungus Smear,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide (Lasix) 100mg Inj,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide (Lasix) 20mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide (Lasix) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide (Lasix) 40mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide (Lasix) 40mg Liquid,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide (Lasix) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide 4ml Va 10mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Furosemide 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,FUSION PLUS,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Fycompa 8 Mg,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin (Neurontin),,,,, $474.88 , $474.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin (Neurontin) 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin (Neurontin) 300mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin (Neurontin) 400mg C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin (Neurontin) 800mg T,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin (Neurontin) Syr : 5,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin 200 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin 300 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin 600 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabapentin 800 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabitril (Tiagabine)2 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabitril 12mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabitril 16 Mg,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabitril 6 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gabitril 8 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gair Built Blue,,,,, $73.14 , $73.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gait Training 15 Min,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Galantamine (Razadyne) Tab : 4,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Galantamine Hb 212 M,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Galantamine Hbr 16 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Galantamine Hbr 4mg Tab,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Galantamine Hbr 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Galantamine Hydrobro (Razadyne,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ganciclovir (Cytovene) 500mg I,,,,, $350.00 , $350.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ganciclovir Sod OP (Cytovene),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Garment Dvt Foot Universal,,,,, $323.30 , $323.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Garment Dvt Large Calf,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Garment Dvt Large Thigh,,,,, $361.46 , $361.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Garment Dvt Medium Thigh,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gas X 180 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastric Emptying Scan,,,,," $5,148.42 "," $5,148.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastric Sump Tube Fr,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastrin Serum,,,,, $391.14 , $391.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastro Tube 16FR 5cc MIC Tube,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastro Tube 18FR 10cc MIC Tube,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastro Tube 20fr 10cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastro Tube 24fr 20cc Mic Tube,,,,, $50.88 , $50.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastrographin Liquid,,,,, $434.60 , $434.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gastrostomy Tube Change,,,,," $3,265.86 "," $3,265.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gatifloxacin (Zymar) Sol : 0.0,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze 4x4 10 Pk,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze Bordered 4x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze Bordered 6x6 Ns,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze Bordered Antimicro 4x4,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze Brdr 4x5 2x2.5 Pad Steri,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze Kerlix Roll,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze Roll 45""x4.1 Yds",,,,, $5.30 , $5.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze Spg,fluff 4x4, 12ply Str",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze Spong 4x4 12ply 10s Ster,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze Sponge (2x2),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gauze Sponge (4x4),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze, Conforming Roll 2""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze, Conforming Roll 3""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze, Conforming Roll 4""",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze, Sponge 2x3",,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze,packing Strip Iodoform",,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze,sponge,4x4,12ply,ster,lf",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Gauze,sponge,fluff 6x6.75",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gaviscon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gaviscon 20-80 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gaviscon 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gemfibrozil (Lopid) 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gemfibrozil 600 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gen Teal Gel Tube,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Genasyme 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Genebs 500mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,General Anesthesia,,,,," $2,207.98 "," $2,207.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,General Health Panel,,,,," $1,186.14 "," $1,186.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,General Recovery,,,,," $1,500.00 "," $1,500.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Generlac Soln 10g/15ml,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentacidin 3mg/ML,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin (Gentak) 0.3% Opth,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin 0.1% Oint,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin 100 Mg Im,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin 3.75 Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin 40mg/ML 80 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin 80 Mg Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin Im 2ml Vial,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin Level,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin Opth Sol 5ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentamicin Sulf (Gentak) Oin :,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Genteal Drops,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Genteal Eye Drps 15 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gentian Violet Liq : 0.01,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 10 Mg,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 10mg Injection,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 20 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 20 Mg/Inj,,,,, $654.00 , $654.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 30 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 40 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 40 Mg Im,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 5 Mg Im,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 60 Mg Tab,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geodon 80 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geri Chair Cushion,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Geritol Complete,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ggt,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gi Bleeding Scan Acute,,,,," $5,990.06 "," $5,990.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ginko Biloba 60 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glcagon Inj,,,,, $529.00 , $529.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glimepiride (Amaryl) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,GLIMEPIRIDE 1 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glimepiride 2 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glimepiride 4 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glimepiride 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide (Glucotrol) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide 15 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide E-R 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide Xl (Glucotrol Xl) 2.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide Xl (Glucotrol) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glipizide Xl 10mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gloucose Body Fluid,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glove Large Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glove Med Exam Pf Latex-Free,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glove Small Nitrile Exam Pf La,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gloves Large Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gloves Medium Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gloves Xlarge Blue,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucagon 1 Mg Emer Kit,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucagon 1 Mg Im,,,,, $605.00 , $605.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucagon 1mg Inj,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucerna,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucerna 1.2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucerna 1.5 Cal 8 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucometer Lab,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucophage 250 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucophage 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucophage HCL 850 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucophage Xr 500mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucosamine 1000 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucosamine 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucosamine Complex 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucosamine/Chondroiton,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose (Insta-Glucose) Gel 15,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose 5 Hr,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Body Fluid Miscel,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose G6pd,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Gel,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Random,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Spinal Fluid,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Strip,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Tablets,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Tol 1 Hr,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Tol 1st 3 Specimens,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Tol 2 Hr,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Tol Add Specimen,,,,, $64.66 , $64.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucose Whole Blood,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucotrol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucotrol 5mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucotrol Xl 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucovance 2.5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucovance 5/500,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucovance 5/500 Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glucsoe Blood,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glutamic Acid Decarboxylase,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glutose 15 Gel Tube,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glutose 5 Gm Chews,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide (Diabeta) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide (Glynase) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide 2.5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide 3 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide Tab : 1.25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyburide/Metformin 5/50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycerin Adult Supp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycerin Pediatric Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycerin Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,GLYCERIN SUPPOSITORY,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycolax 255 Gram,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glyconhemoglobin A1c,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycopyrrolate (Robinul Forte),,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycopyrrolate (Robinul) 0.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycopyrrolate (Robinul) 1mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycopyrrolate 2 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glycosylated Hemoglobin,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Glynase 3mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gm 1 Auto Antibody,,,,, $519.40 , $519.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,GOLD BOND FOOT PDR 10 OZ,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gondrrhea by Ona Prose,,,,, $208.82 , $208.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Goserelin Acetate (Zoladex) Sy,,,,," $7,368.00 "," $7,368.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gown Iso Mdwght Elstwrst Lv2lg,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gown Iso Mdwght Elstwrst Lvreg,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gown Isolation Reg Yellow Flui,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Graduated Container,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gram Stain,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Granisetron HCL (Kytril) Vl :,,,,," $1,020.00 "," $1,020.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Granulex Spray 4 Oz,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Grav Set W/Rate Flow Reg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Griseofulvin 250 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Griseofulvin Ultrami (Gris-Peg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Growth Hormone (Hgh),,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gs Century Vits,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gs Clear Lax 30 Cc (Colace),,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gs Lice Shampoo 4 Oz,,,,, $58.24 , $58.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gs Throat Spray 6 Oz Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gt Bag,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaif/Carbpent (Betavent) Btl,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaif/Pseud Sa (Maxifed) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaif/Pseud/Dm Sa (Maxifed) Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifen/P-Ephed Sr (Maxifed G),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifen/P-Ephed/Cod (Phenylhis,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifen/P-Ephed/H-Co (Drituss,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifenesin (Robitussin) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifenesin 200 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifenesin 237 ML Bottle,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,GUAIFENESIN 400 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifenesin ER 600 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifenesin Sa (Mucinex) 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifenesin/Codeine (Guaifen A,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifenesin/Dm Sr (Allfen Dm),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guaifenesin/D-Meth (Robitussin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gualfensin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guanfacine 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guanfacine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guanfacine HCL Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guanfucine 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guar Gum (Benefiber) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guiatuss Dac Syr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guid Placmt Cath Drng Abs,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guide Perc Drng Absc S&i,,,,," $2,981.78 "," $2,981.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Guide Thoracent/Abd Para,,,,," $1,080.14 "," $1,080.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gwatuss 100mg/5ml,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Gynalotrimin,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,H Influ Gp B Antigen Eia,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,H Pylori,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hair and Body Shampoo,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hair Brush,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 0.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 10 Mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 2 Mg Vial,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 5 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 5 Mg Inj,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol 5mg/ML,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol Concentrate 120 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol Dec 1ml/100 Mg,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol Deconate 100 Mg Im,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol Deconate 50 Mg Im,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haldol Liq 2/1 5ml,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Halls Mentolyptus (60),,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol (Haldol) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol (Haldol) 5mg/ML In,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 0.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 15 ML Bottle,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,HALOPERIDOL 15 ML BOTTLE,,,,, $55.28 , $55.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 2.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol 5mg/ML Dupont,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol Dec 100/ML,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,HALOPERIDOL DEC 50 MG/ML,,,,, $172.60 , $172.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol Decanoate (Haldol),,,,, $466.00 , $466.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol ML 120,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haloperidol Oral Sol 60 ML,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Halothane Liquid 250ml,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand 2 Views,,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Complete,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Complete I/F,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Control Mitt,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Min 3 Views,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Pitt Padded,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Splint Air Sft Res Med Rt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Splint Air Sft Rest Lg Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Splint Air Sft Rest Md Lt,,,,, $398.56 , $398.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hand Two Views,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Handling Fee,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Haptoglobin Quant,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hcts 1% 30gm,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hctz 12.5 Capsule,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Headphone Foam Replacement Pad,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heavy Metal Qt Each,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hectorol 0.5 Mcg Tab,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heel Oscalcis Min 2v,,,,, $334.96 , $334.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heel Protectors,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heel Suspension Boot,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Helicobactor Pylori Stool,,,,, $251.22 , $251.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hematocrit,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hematocrit Spun,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hematogen Capsule,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemmorrhoidal Cr,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemo Influenza,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemocyte Plus,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemocyte Plus Cap,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemodialysis,,,,, $549.08 , $549.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemoglobin,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,HEMOGLOBIN A1C,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemoglobin Electroph,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemoglobin Fetal (Qual),,,,, $294.68 , $294.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemoglobin Fetal Lysis,,,,, $332.84 , $332.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemoglobin Plasma,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemoglobin Urine,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemogram/Platelet Automated,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemorrhoidal Hc Supp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemosiderin,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hemostat Absorbable,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Hep C Pcr,quant",,,,, $285.00 , $285.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hep C Viral Rna/Dna,,,,, $647.00 , $647.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hep E Virus Igg Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hep E Virus Igm Antibody,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hep Loc Flush 100u/ML Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hep Loc Interlink 2/Extension,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hep Loc Interlink Inj Site,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hep Lock 100u/ML 30 ML,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heparin 1000 U/ML 30ml Vl,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heparin 25000 Units/D5w 500mls,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heparin 5000 Unit Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heparin 5000 Units Inj,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heparin Antibody,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heparin Lock Flush 100 Units/M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heparin Sodium Inj 3000u/30ml,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatic Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis A Antibody Igm,,,,, $342.38 , $342.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis B (Recombivax) 10mcg,,,,, $391.00 , $391.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis B Core Ab,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis B Core Ab G&m,,,,, $356.16 , $356.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis B Dna/Pcr Dir Probe,,,,, $575.58 , $575.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis B Surf Ab,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis B Surf Antibody,,,,, $83.74 , $83.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis Be Ab Hbeav,,,,, $203.52 , $203.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis Be Antigen,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis C Antibody,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis C Quant,,,,, $250.16 , $250.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis C Riba,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Hepatitis C, Ab",,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitis C/Rna/Pcr,,,,, $922.20 , $922.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Hepatitis E, Ab",,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitus B Srfce Ag,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepatitus Panel,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hepato Scan W&w/O Cb Func,,,,," $2,805.82 "," $2,805.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Her Simplex 1 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Her Simplex 2 Pcr Dir Probe,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Herpes Simplex Iab Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Herpes Simplex Igg,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Herpes Simplex Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Herpes Virus Isol,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Herpes Virus Non Spe,,,,, $348.00 , $348.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hetastarch 6% (Hespan) Inj : 0,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Heterophile Abititer,,,,, $209.88 , $209.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hexachlorophene (Phisohex) 3%,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiaa Urine,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hibiclens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hibiclens 4% Liq 4 Oz,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,High Flow Humidification Syste,,,,, $167.48 , $167.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,High Flow Nasal Cannula-Green,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hip 2 Views I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hip Kit,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hip Min 2v,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hip Operative Proc,,,,, $939.16 , $939.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hip Uni Two Views,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hip Unilat 1 View,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hip/Pelvis 2 Views,,,,, $576.64 , $576.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Histoplasma Antigen,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiv,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiv Dna by Pcr,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiv Viral Load,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiv Western Blot,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiv-1,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Hiv-1 and Hiv-2, Single Assay",,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiv-1 Antibldy,,,,, $404.92 , $404.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiv-1 by Pcr,,,,, $395.38 , $395.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hiv-1 Rna by Pcr Quant,,,,, $702.78 , $702.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hla Typing B27,,,,, $649.78 , $649.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Holder Trach Tube One Size Fit,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Holter Monitor 24hr,,,,, $414.00 , $414.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Holter Monitor Record/Hookup,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Holter Monitor Scanning Analys,,,,, $256.52 , $256.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Homocystine Serum,,,,, $442.02 , $442.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Horizon Tubing,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hose Anti Emb Thigh Lg Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hose Anti-Emb Knee Lg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hose Anti-Emb Knee Md Reg,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hose Anti-Emb Knee Sm,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hose Anti-Emb Knee Xl,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hose Antiemb Kneexl Reg,,,,, $22.26 , $22.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hose Antiemb Thigh Xl Reg,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hose Anti-Embolism Stocking,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Hose, Care Knee",,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hot Packs,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hoyer Lift Pad,,,,, $659.00 , $659.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hpv Culture,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Huberwing Infset Gx1-1/2""6""tub",,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hum Benzoin Compound,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,HUMALOG 50/50 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humalog 75/25 Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humalog Ins Inj,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humalog Insulin U-100 1oml,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,HUMALOG U-100 EACH UNIT,,,,, $1.32 , $1.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humerus,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humerus Min 2v,,,,, $366.00 , $366.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humid Aquapak 650ml H20 W Ada,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humid Vent 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humilin 70/30 Inj ML 1 Unit,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humira 40 Mg/0.8 ML,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humulin 70/30,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humulin 70/30 Ins Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humulin N Insulin Each Unit,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,HUMULIN R EACH UNIT,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Humulin R Insulin U 100,,,,, $140.00 , $140.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyazzr 50-12.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hycodan Liq 1.5mg/5ml,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydraguard/Skin Cream,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine (Apresoline) 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine (Apresoline) 20mg/,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine (Apresoline) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine 25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydralazine 75 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrea 500 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydro Gel Pump 3oz,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydro Valerate 0.2%,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrochlorothiazide (Hctz) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrochlorothiazide 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrochlorothiazide 50 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrochlorothiazide 6.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrochlorthiazide 12.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocholorothiazide 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone 2.5/500 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone Apap 2.5/250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone Apap 7.5/500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap (Lorcet Plus),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap (Lortab) Elxi,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap (Lortab-10) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap (Vicodin) 5/5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap 10/325 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap 10/500,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap 10/650,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap 2.5/162.5,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap 3.75/162.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,HYDROCODONE/APAP 5/162.5 MG,,,,, $1.92 , $1.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap 5/500 Wt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Apap 7.5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Chlorphen (Tussion,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Dpm Psxs1m,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Guaifen (Cotuss-V),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone/Ibuprofen (Vicopro,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocodone-Apap 5/3,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocort 2.5%,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortison Val Crm,,,,, $298.00 , $298.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone (Anusol Hc) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone (Anusol Hc) Cre,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone (Proctocort) Cr,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone (Solu-Cortef) 1,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,hydrocortisone 0.5% cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone 1% Cream 1oz,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone 2.5% Cream 20gm,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone 5 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone Cream 1%,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone Cream 2.5%,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone Na Su (Solu-Cor,,,,, $584.00 , $584.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone Sup T 25,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone Valerate 0.2% C,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone/Acetic 10 ML,,,,, $684.00 , $684.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone/Acetic Acid Oti,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocortisone/Pramoxine (Epif,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrocotisone 1% Cr 1oz,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrofera Blue Wound Dressing,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrogel (Saf-Gel) 3oz.,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrogel Dressing,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrogel Dressing 4x4,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydrogen Peroxide,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydromophone 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydromorphone (Dilaudid) 2mg I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydromorphone (Dilaudid) 2mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxychloroquine (Plaquenil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxychloroquine 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxychloroquine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxychloroquine 200m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxycorticoster17-Oh,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxycorticosteriods,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyindolacetic 5-Hiaa,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyprogesterone 17-D,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyproline Free,,,,, $986.86 , $986.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyurea 500mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine (Atarax) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine (Atarax) 10mg/5ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine (Atarax) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine (Vistaril) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine (Vistaril) 50mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine HCL (Atarax) Syr :,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine HCL 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine HCL 25mg Vl,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzine Pam 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hydroxyzome 50 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hygroscopic Condenser Humidifi,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyomax 0.125 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyoscyamine (Levsin) 0.125mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyoscyamine ER 0.375mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyoscyamine S/L.125 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyoscyamine Sulfate (Levsin) I,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyoscyamine Sulfate Drp : .125,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hypafix Tape (1 Roll),,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hypotears Eye Drops,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hysterosalpingography S&i,,,,," $1,105.00 "," $1,105.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hytrin,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyzaar 100/12.5 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Hyzaar 50/12.5 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,I Caps Plus,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,I Car-C Plus Sr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,I Vite,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,I&d Abscess Comp/Mult,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,I&d Abscess Simp/Sgl,,,,, $698.54 , $698.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,I&d Cyst Complex,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,I&d Cyst Simple,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,I-123 Capsule 200 Uci,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibuprofen (Motrin) 100mg/5ml S,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibuprofen 100 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibuprofen 100 Mg/5 ML,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibuprofen 200mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibuprofen 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibuprofen 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibuprofen 600mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibuprofen 800 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ibutilide Fumarate (Corvert) V,,,,," $1,681.00 "," $1,681.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Icaps M/V (Eye),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Icar C 100/250 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Icy Hot Cream Cream :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iep Except Serum,,,,, $139.00 , $139.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iep Serum,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ileostomy Bag,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Imdur 20 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Imdur 30 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Imipenem/Cilastatin (Primaxin),,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Imipramine (Tofranil) 25mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Imipramine 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Imipramine HCL 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immitrex 50 Mg,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immodium 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immundelectrophoresis,,,,, $363.58 , $363.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immundelectrophoresis Ur,,,,, $546.96 , $546.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immune Globulin (Gamunex) 5gm,,,,," $3,165.00 "," $3,165.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immune Globulin (Ivig) Vl : 1g,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immunocytochemistry Ea Antibdy,,,,, $368.88 , $368.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immunoelec/Other Fluids,,,,, $562.86 , $562.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immunoglobulin E,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immunoglobulin Iga Only,,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immunoglobulin Igg Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immunoglobulin Igm Only,,,,, $245.92 , $245.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immunoglobulin;subclass,,,,, $744.12 , $744.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Immunolgobulin Igo,,,,, $677.34 , $677.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Impramine,,,,, $427.18 , $427.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inapamide 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Incentive Spirometer,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,INCRUSE ELLIPTA 62.5 MCG INH,,,,," $1,194.00 "," $1,194.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indapamide (Lozol) 2.5mg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indapamide 1.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inderal 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inderal 25 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inderal 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inderal La 120 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inderal La 60 Mg Propranolol,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,India Ink Prep,,,,, $111.30 , $111.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indinavir Sulfate (Crixivan) C,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indirect Coombs,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indocin 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indocin Sr 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indocyanine Green (Ic) Vl : 25,,,,, $553.00 , $553.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indoigotindisulfonat (Indigo C,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indomethacin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indomethacin (Indocin) 25mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indomethacin 25mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indomethacin 50 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Indomothacin 25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Infliximab (Remicade) Vl : 10m,,,,," $3,652.00 "," $3,652.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Influenza (Fluzone) Vaccine,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Influenza Ab Ag by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Influenza B by Dfa,,,,, $126.14 , $126.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Influenza Ivr B Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Influenza Vir A Ag Eia Scn,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Infusion Therapy,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Infusion Therapy 0-2 Hrs,,,,," $2,108.00 "," $2,108.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Infusion Therapy 2-4 Hrs,,,,, $421.00 , $421.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Infusion Therapy 4-6 Hrs,,,,, $844.00 , $844.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Infusion Therapy/Per Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Infusion Therapy/Visit,,,,, $502.00 , $502.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inj or Cath Fluoro Guid S&i,,,,, $475.94 , $475.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inner Cannula Shiley Size 4,,,,, $135.21 , $135.21 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inner Cannula Shiley Size 8,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Innopran Xl 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ins Bile Duct Drain CPT,,,,," $1,930.26 "," $1,930.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ins Chest Tube,,,,, $642.36 , $642.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insert Central Line Percu,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insert Pacemaker CPT,,,,," $3,279.64 "," $3,279.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insert Pacemaker Perm Du,,,,," $4,208.20 "," $4,208.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insert Pacemaker Perm Sg,,,,," $2,903.34 "," $2,903.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insert Pacemaker Temp,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insert Single Chamber Icd,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insert Temp Pacemaker Sur Sing,,,,," $1,815.78 "," $1,815.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insert/Repos Single Icd+lead,,,,," $5,344.52 "," $5,344.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Inspra 25 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insrt Non-Tunneld Cvad >= 5yr,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insrt Tunneled Cvad >= 5yr Sur,,,,," $3,210.74 "," $3,210.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insta Glucose Gel,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Instaflex Joint Support,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulated Water Carafe,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin (Novolin R) 100u/ML,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin (Novolog Mix 70/30) 10,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Antibodies Beef Pk,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Detemir (Levemir) 100,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Ext Zn Humana (Humulin,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Glargine (Lantus),,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Human (Humalog Mix) 75,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Human (Humalog) 100 Un,,,,, $591.00 , $591.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Human (Novolin) 70/30,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Humulin L Vl : 100unit,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Humulin R,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Novolog Vl : 100units,,,,, $437.00 , $437.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Nph (Novolin N) Vl,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insulin Total,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Insye Autoguard IV 22 Ga 50 Bx,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Int Cath Aorta CPT,,,,," $1,117.24 "," $1,117.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Int Cath CPT 1rst Ord Vein CPT,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Int Cath CPT Ren Pelv CPT,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Int Cath Ret Brach Art CPT,,,,, $786.52 , $786.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Int Cath Sup/Inf Vna Cava CPT,,,,, $659.32 , $659.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Int Extremity Artery CPT,,,,, $531.06 , $531.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Int/Ex Biliary Stent/Drain S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Integra Vit,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Interferon Beta Inj 0.3,,,,," $2,076.00 "," $2,076.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Interlink Coninu Flo Sol Set,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Interrupt Part/Comp Vena Cava,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intralipids 20% 100ml,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intrinsic Factor,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Cath Main Pulmon Artery,,,,," $3,668.66 "," $3,668.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Cath Sup/Inf Vena Cava,,,,," $2,935.14 "," $2,935.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Cath/Stent Renal Pel Drn,,,,," $3,743.92 "," $3,743.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Cath/Stent Ureter CPT,,,,," $2,024.60 "," $2,024.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Dil Nephro Tract,,,,," $1,605.90 "," $1,605.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Intra/Cath Renal Pelvis,,,,, $482.30 , $482.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Ndl/Cath Brach Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Needle Intracath Ext Art,,,,, $586.18 , $586.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intro Needle/Intracth Av Stunt,,,,," $2,245.08 "," $2,245.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Introcan 22g 1 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Introcan 24g 3/4 In,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Intubation,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Invega 3 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Invega 6 Mg Tab,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Invega 9 Mg Tab,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Invokana 100 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,INVOKANA 300 MG,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ioban Steri Drape,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iodine Prep,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ip Ini Limited,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ipratr-Albuterol 0.5 90,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ipratropium (Atrovent) 0.02% I,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ipratropium (Atrovent) 0.06% N,,,,, $327.00 , $327.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ipratropium (Atrovent) Inhaler,,,,, $492.00 , $492.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ipratropium 0.02% 5mg Vial,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ipratropium Br (Atrovent) Spy,,,,, $270.00 , $270.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ipratropium Bromide 0.2,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ipratropoim 0.02% 05mg/2.5ml,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Irbesartan (Avapro) 150mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Irbesartan 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IRBESARTAN 300 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IRBESARTAN 75 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iron,,,,, $170.66 , $170.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IRON 100-VITAMIN C,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iron Binding Capacity,,,,, $54.06 , $54.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iron Dextran (Infed) 100mg Inj,,,,," $1,797.00 "," $1,797.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iron Liquid 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iron Polysaccharide (Niferex E,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iron Polysaccharide (Niferex),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iron Prep/Fa/Mvi (Rephiva) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Iron Serum,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Iron,vit C, Vit B12, Folate",,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Irrigation Tray W/Bulb Syr Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Irrigation Tray W/Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isentress 400mg Tablet,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Islet Cell Antibody,,,,, $307.40 , $307.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ismo 20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isometh/Dichlor/Apap,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isoniazid 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isoniazid Tab : 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isoproterenol (Isuprel) 1mg Am,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isoptin HCL Sa 120 Mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isopto Tears,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isordil 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbid Mn ER 120 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide 20mg Oral Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Dinitrate,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Dinitrate (Isordil),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Dinitrate 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Dinitrate 20mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Dinitrate 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Mnit Tab : 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Mon 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Mon ER 60 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Mononitrate (Imdur),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide Mononitrate (Ismo),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isosorbide3 Mononitrate 60mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isradipine (Dynacirc Cr) Tab :,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Isradipine (Dynacirc) 2.5mg Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Itraconazole (Sporanox) 100mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Itraconazole 100 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Cath 18x1-1/4 Surflo 50 Box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Cath 20x Iag Saf 50box,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Cath Ext Set Microbore,,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Filter Set .22 Micron 50cs,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Infusion Additional Hour,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Infusion Therapy 1 Hour,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Medication 1-2 Meds,,,,, $231.00 , $231.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Medication 3+ Meds,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Nacl,,,,, $204.00 , $204.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Pump Daily,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Saline Mixture Bag,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"IV Set 18"" Dial Flo Clv",,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"IV Set Bc 23x3/4 7"" Tb W/Lr",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"IV Set Secondary Clearlink 35""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,IV Start Kit,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ivp Retrograde,,,,," $1,017.60 "," $1,017.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ivp W/ Nephrotomgraphy,,,,, $948.00 , $948.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ivp W/Wo Kub W/Wo Tomos Dd,,,,," $1,013.00 "," $1,013.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ivus Add Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ivus Periphial Addl Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ivus Periphial Initial Surg,,,,," $3,236.18 "," $3,236.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ivus Supervision S&i,,,,, $346.62 , $346.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Jalyn 0.5 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Jantoven 2.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,JANTOVEN 4 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Jantoven 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Janumet 50/1000 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,JANUMET 50/500 MG,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Janumet 50-1,000 Mg",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Januvia 100 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Januvia 25 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Januvia 50 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,JARDIANCE 10 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,JARDIANCE 25 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Jc Virus by Pcr,,,,," $1,089.68 "," $1,089.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Jel Lube Nova Pl ST Foil Pk 3g,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Jelly Lube Strl Foil Pack 3gm,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Jevity 1.5,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Johnsons Baby Shampoo,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,J-Tan D Sr,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Juven,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Juven 23 Gram Pkt,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K + Elexir 10% 60 ML Bottle,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K Clor 8 Meq,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K Dur 20 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K Dur 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K Dur 30 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K Dur 40 Meq,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K Phos,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K Vescent 25 Meq Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kaletra Liquid 160ml,,,,," $1,273.00 "," $1,273.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kaletra Tab 200-50mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kanamycin Sulfate (Kantrex) Vl,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kaolin Pectin 30 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,KAOPECTATE 30 CC,,,,, $3.60 , $3.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Karaya Paste - Gulf South,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kayexalate 15 Gm,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kayexalate 30 Gm,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kayexelate 15gm In 60ml Sorbit,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 10 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 10% 105 ML Bottle,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 10% 120 ML Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 10% 240 ML Bottle,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 10meq In 100ml Sol : 0.1me,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 20% 60 ML Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 20% 75 ML Bottle,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl 8 Meq,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kcl Sol'n 10% 20meq/15ml,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keflex 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keflex 500mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kell Ag Titer,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kenalog,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kenalog Cm 80gm Tube,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kenalog Lotion 1%,,,,, $461.00 , $461.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keppra 1000 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keppra 120 Cc Bottle,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keppra 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keppra 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keppra 750 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keppra Liquid 70cc Bottle,,,,, $306.00 , $306.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Keppra Serum,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kerlix,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kerlix Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketamine 100mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketocanazole 2% Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketocanazole Cr 2%,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketoconazole (Nizoral) 200mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketoconazole (Nizoral) Cream,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketoconazole (Nizoral) Shampoo,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketoconazole 2% Cream,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketoconazole Shampoo 120oz Bot,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketone Serum,,,,, $169.60 , $169.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketorolac (Acular) Ophth Sol 0,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketorolac (Toradol) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketorolac (Toradol) 30mg Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketorolac 60mg Vial Ftv : 30mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketorolac Tromethamine 30,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketosteriods,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketosteroids 17-Ks Fract,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ketosteroids 17-Ks Total,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,KETOTIFEN FUM 0.25% EYE DROPS,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kidney Imaging W/Vasc Flow,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kidney W/ Flw & Func W/&w/O Ph,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kidney W/Flow & Funct W/Phar,,,,," $2,652.12 "," $2,652.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kidney W/Flow& Funct W/O Phar,,,,," $1,516.86 "," $1,516.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kinetic Excercises,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kit Drain Clamp 44mm 1-3/4 Flg,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kit Drop Foot Boot,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit IV Start, Sepp & Statlock",,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit Midstream Bzk 4ozcup,basic",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kit Staple Removal Deluxe Prov,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kit Suture Removal,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit, Arterial Line, 18g",,,,, $157.94 , $157.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit, Blood Sampling,arterial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,abg,pulset,cricket 23gx1n",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,arterial Line, Sterlile",,,,, $220.48 , $220.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,cat,suct,14fr,whistl,2glv",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,cath Suction,10fr,2glv,min",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,catheter,cvc,triple Lumen",,,,," $1,022.90 "," $1,022.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,introducer,percu,sheath",,,,, $430.36 , $430.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,pneumothorax,8fr Cath,safe",,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,skin Staple Remover,gauze",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,suct,canister 1500cc W/Tub",,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,suct,cath Mini 14fr Whistl",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,suction,oral,vaprevent W/C",,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Kit,trach Care,clsd Et Suc 14f",,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kleenex,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kleihauer-Betke,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Klonopin 0.125 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Klonopin 0.25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Klonopin 0.5 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Klonopin 1 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Klonopin 2 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Klor Con 10 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Klor Con 20 Meq,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K-Lyte Ci Eff Tb 25 Meq,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee 1 or 2 Views,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee 2 Views I/F,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee 3 Views,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee Ap and Lateral,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee Completed,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee Immobilizer,,,,, $271.24 , $271.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee Length Scd Sleeve,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee Min 4v,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Knee Support Brace,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Koh Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kombiglyze Xr 2.5/1000 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Konsyl Powder,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kristalose 10mng Pckt,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kub,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kwell Lotion 60ml,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,K-Y Jelly 2 Oz.,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kyphoplasty Ea Vertebra S&i,,,,, $431.00 , $431.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Kyphoplasty Surgical Proc Surg,,,,," $7,211.18 "," $7,211.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,L Methylfolate Cal 15 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,L Thyroxine 125 Mcg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,L Thyroxine 25 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,L/S Ratio,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,L/S Ratio Quant,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Label IV Day of Week,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Labetalol (Trandate) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Labetalol (Trandate) 5mg/ML Md,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Labetalol 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Labetalol 400 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LABETALOL 50 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Labetalol HCL,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Labetalol HCL 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Labetalol HCL 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LAC-HYDRIN 5% LOTIION,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lacri-Lube 7gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lacrilube Oint,,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactaid,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactaid Fast Act,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactated Ringer (Lr 1000ml) IV,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactic Acid,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactinex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactobacillus (Culturelle) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactobacillus Acid Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactoferrin by Eia,,,,, $216.24 , $216.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactulose 10 Gm/5ml 8 Oz 237ml,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactulose 10gm/15ml Sol,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactulose 15ml Dose,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactulose 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactulose 30 ML Voc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lactulose Sol 473ml,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamicatal 200 mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamictal 100mg,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamictal 150mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamictal 200 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamictal 25 Mg Tab,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamictal 25mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamictal Tablets 100 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamis/Hydroc/Bacto Compound,,,,, $171.00 , $171.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamisil,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamisil 250 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamivudine (Epivir) Tab : 150m,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamivudine/Zidovudin (Combivir,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamotrigine (Lamictal) 200mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamotrigine (Lamictal) Tab : 2,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamotrigine 100 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamotrigine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamotrigine 200 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamotrigine 25mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LAMOTRIGINE 50 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lamotrigine 75 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lanacane Compound Oint,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lancet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lanciceptic Protective Barrier,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lanolin/Min Oil/Pet (Lacri-Lub,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lanoxin .125 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lansoprazole (Prevacid Solutab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lansoprazole (Prevacid) 30mg P,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lansoprazole Ec 15mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lansoprazole Ec 30mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lantiseptic Crm 50%,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lantiseptic Oint 4.5oz,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lantiseptic Skin Protec .5pkt,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lantus 100 Units/ML,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LANTUS EACH UNIT,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lantus Insulin 100,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lantus Insulin Inj,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LANTUS SOLO DISP PEN,,,,," $1,766.00 "," $1,766.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Large Disposable Sling 10 Case,,,,, $97.52 , $97.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Large Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Laser Dop Thermal Imag Art Uni,,,,, $558.62 , $558.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lasix 40 Mg Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Latanoprost (Xalatan) 0.005% E,,,,, $353.00 , $353.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Latanoprost Drp 0.005%,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Latanoprost Opth Sol,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LATUDA 10 MG,,,,, $99.91 , $99.91 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Latuda 20 Mg,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Latuda 40 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LATUDA 60 MG,,,,, $144.00 , $144.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Latuda 80 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Laxative Suppository,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LDH,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LDH Body Fluids,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LDH Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LDH Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ldl Measured,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lead Blood,,,,, $304.22 , $304.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lead Urine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lecithin 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Leflunomide (Arava) 10mg Tab,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LEFLUNOMIDE 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Legionella Antibody,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Legionella Antigen Urine,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Legionella Dir Flour Ab,,,,, $355.10 , $355.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lemon Glycerin Swabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lepirudin (Refludan) 50mg Inj,,,,," $1,045.00 "," $1,045.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lescol 20 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lescol Xl 80mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Letrozole Tab 2.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Leukocyte Alkaline Phos,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Leukocyte Assmnt Fecal Qual/Qu,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Leukopoor Red Blood Cells Prod,,,,," $1,138.44 "," $1,138.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levalbuterol (Xopenex) 0.63mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levalbuterol (Xopenex) 1.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levalbuterol (Xopenex) Hfa Mdi,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levalbuterol Sol 0.63 Mg,,,,, $972.00 , $972.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levaquin 250 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levaquin 500mg,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levaquin 750 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levbid ER 0.375mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levemir 100 Units/ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levemir Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levemir Flexpen,,,,," $1,510.00 "," $1,510.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levemir Vl,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam (Keppra) 100 Mg/,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam (Keppra) 500mg I,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam (Keppra) 500mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 1000 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 105 ML Bottle,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 120 ML Bottle,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LEVETIRACETAM 21 ML BOTTLE,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 500mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levetiracetam 90 ML Bottle,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levobunolol O/S Sol : 0.005,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LEVOCETIRIZINE 5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levofloxacin (Levaquin IV) 250,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levofloxacin (Levaquin IV) 500,,,,, $239.00 , $239.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levofloxacin (Levaquin IV) 750,,,,, $317.00 , $317.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levofloxacin (Levaquin) 500mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levofloxacin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levofloxacin 250 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levofloxacin 500 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levofloxacin 750 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothroid .05 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothroid .15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothroid 0.1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothroid 0.125,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothroid 100 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothroid 175 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothroid 75mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothryoxine 88mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroid 25mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine (Synthroid) 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine (Synthroid) 112m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine (Synthroid) 125m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine (Synthroid) 200m,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine (Synthroid) 50mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine (Synthroid) 75mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine (Synthroid) 88mc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 100 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LEVOTHYROXINE 137 MCG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 150 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 175mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 25mcg Tab,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 50 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 75mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine 88 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sod 100mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sod 125mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sod 150 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sod 175 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sod 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sod 50 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sod 75mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sod 88 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levothyroxine Sodium 112 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levoxyl 100 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levoxyl 75 Mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Levthyroxine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lexapro 10 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lexapro 15 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lexapro 20mg Tablet,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lexapro 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lexapro 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lexapro 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lialda 1.2 Gm,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Librax 5/2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Librium 25 Mg Cap,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Librium 5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Librium 50 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lice Comb Ea,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lice Treatment,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lice Treatment 1% Cream Rinse,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidex .05% 15 Gu,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lido/Antacid/Diphen/Prom 60cc,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocain 1% 10mg/ML Inj,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine,,,,, $407.04 , $407.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine (Lidoderm) Patch,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine (Xylocaine) 2% Jelly,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine 1% 20 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine 1% Vial 20ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LIDOCAINE 1% VIAL 50 ML,,,,, $31.64 , $31.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine 2% Ansyr (Lidocaine,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine 2% Inj 20ml Vial,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine 2gm D5w 500ml Drip,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine 4% (Lidocaine) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine Ftv : 0.005,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine HCL (Local) (Xylocai,,,,, $342.00 , $342.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine HCL (Uro-Jet) Jel :,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine HCL Topical 5%,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine Patch 5%,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine Patch 5% 1/2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine Viscous 2% 20ml U/D,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine Viscous 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine/Benadryl Elix 40 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine/Epi (Xylo/Epi) Vl :,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine/Epi (Xylocaine With,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidocaine/Prilocaine (Emla) Cr,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lidoderm 5% Patch,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Limbitrol Ds 10/25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Limbrel 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LINDANE SHAMPOO 1%,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lindane Shampoo 60ml,,,,, $681.00 , $681.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Liner,incont,milimed Maxi 8x1",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Linezolid (Zyvox IV) 600mg Bag,,,,, $622.00 , $622.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Linezolid (Zyvox) 100mg/5ml or,,,,," $2,385.00 "," $2,385.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Linezolid (Zyvox) 600mg Tab,,,,, $453.00 , $453.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LINZESS 145 MCG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LINZESS 290 MCG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lioresal 10mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LIOTHYRONIN 5 MCG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liothyronin 50 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liothyronine (Cytomel) Tab : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LIOTHYRONINE 2.5 MCG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liothyronine Sod 12.5 Mcg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liothyronine Sod 25 Mcg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LIOTHYRONINE SOD 50 MCG,,,,, $7.96 , $7.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lip Balm,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipase,,,,, $192.92 , $192.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipid Profile,,,,, $377.36 , $377.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipids (Intralipid) 10% 250ml,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipids (Intralipid) 10% 500ml,,,,, $256.00 , $256.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipids (Intralipid) 20% 250ml,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipids (Intralipid) 20% 500ml,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipitor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipitor 20 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipitor 40mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lipitor 80 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liquid Skin Protectant,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LIQUITEARS 1.4%,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril (Zestril) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril (Zestril) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril 15 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril 30 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril 40 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril 5mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril/Hctz 12.5,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril/Hctz 20/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril/Hctz 20/25,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisinopril/Hctz 20/25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lisonopril/ Hctz 20/12.5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium (Lithobid) 150mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium (Lithobid) 300mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium 150 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium 60 Cc Bottle Liquid,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium Carb Lithbid 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium Carbonate 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium Carbonate 300,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium Carbonate 600mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium Carbonate ER 450 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lithium Quan,,,,, $269.24 , $269.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Livalo 2 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LIVALO 4 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liver /Spleen W/Vasc Flow,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liver Funct Study,,,,," $2,514.32 "," $2,514.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liver Function Test Lft,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liver Profile,,,,, $521.00 , $521.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liver Scan (Spect),,,,," $2,047.92 "," $2,047.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liver/Kid Microsomal Abs,,,,, $310.58 , $310.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Liver/Thy/Kid Microsomal Abs,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lmx4 Plus Crm : 0.04,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Local Inflamm Process Wb,,,,," $2,567.32 "," $2,567.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lodine 500 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lodosyn 25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lodrane D24,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lofibra,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loh Isoenzymes,,,,, $416.58 , $416.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loh Serum,,,,, $190.80 , $190.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lomotil 2.5 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lomox Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loniten 2.5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loperamide (Immodium) 1mg/5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loperamide (Immodium) 2mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loperamide 2 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loperamide Hci Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lopid 600 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lopressor 100 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lopressor 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lopressor 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lopressor 75 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loratadine (Claritin) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loratadine 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loratidine/Pseudoephedrine (Cl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam (Ativan) 0.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam (Ativan) 2mg/ML Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam 0.125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam 0.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam 0.5 Mg Inj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam 1 Mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LORAZEPAM 2 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam 2mg Syq,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam 2mg/ML Inj 1ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam 2mg/ML Liq Btl,,,,, $244.00 , $244.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam Intensol 2 (30ml),,,,, $279.00 , $279.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorazepam Tab : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorcet 10/650,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lorcet Plus,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 10/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 10/500 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 2.5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 2.5/500,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 3.75/250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 37.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 5,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 5/250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 5/325 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 5/500 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 500 7.5mg/15ml,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 7.5 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab 7.5/500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab Elix 90 ML,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab Elixir 240 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab Suspension 160 ML Bot,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lortab-5,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Losartan (Cozaar) 25mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Losartan 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Losartan 100/12.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Losartan 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Losartan 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Losartan Pot-Hctz 50/12,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Losartan/Hctz (Hyzaar 50/12.5),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LOSARTAN/HCTZ 100/25 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotemax 0.55 Eye,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotemax Opth 5%,,,,, $657.00 , $657.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotensin 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotensin 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotensin 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotensin 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loteprednol Drop,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loteprednol(Alrex) 0.2% Ophth,,,,, $272.00 , $272.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotion Hand/Body,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotrel 10/20 Mg Capsule,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotrel 2.5/10 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotrel 5/10 Cap,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotrel 5/20 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotrimin 1% Cr. 30 Gm,,,,, $189.00 , $189.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LOTRIMIN CREAM,,,,, $2.36 , $2.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotrisone 15 Grm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lotycin Oint 1gm,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovastatin 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovastatin 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovastatin 20mg(Mevacor),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovastatin 40 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovastatin Tab : 20mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovaza 1 G = 1 Cap,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovaza 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovaza 1000mg Capsule(Omega),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovaza Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovenox 40 Mg/0.4ml Inj,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovenox 40mg,,,,, $210.00 , $210.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovenox 60 Mg Inj,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovenox 80 Mg Sub Q,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovenox Inj 30mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lovenox Mdv : 300mg,,,,," $1,213.00 "," $1,213.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Low Ext Duplex Scan Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loxapine 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loxapine 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loxapine Succinate Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loxapine Succinate Cap : 25mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Loxitane 25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lozol 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lozol 2.5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lozol Tab 2.5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ls Plum Hma Bldol 24/C,,,,, $103.88 , $103.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lsltx Nitrog Plm,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lsplm Cnvpp Clav (48/Case),,,,, $72.08 , $72.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lubiprostone (Amitiza) 24mcg C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lubricant Eye Ointment,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lubricating Jelly,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lubriderm,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,LUCEMYRA 0.18 MG,,,,, $148.72 , $148.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lumigan Eye Drops,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lumigan Eye Drops 0.03%,,,,, $569.00 , $569.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lumigan Opth Sol 0.01%,,,,, $692.00 , $692.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lunesta 1 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lunesta 2 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lunesta 3 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lung Perfusion,,,,," $3,400.48 "," $3,400.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lung Vent Gaseous Sngl Proj,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lung Ventilation Scan,,,,," $1,928.14 "," $1,928.14 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lupus Anticoagulant,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Luteinizing Hormone,,,,, $533.18 , $533.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lyme Disease Antibody,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lyrica 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lyrica 150 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lyrica 200 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lyrica 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lyrica 300 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lyrica 50 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Lyrica 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,M9 Drop Deodorizer 1oz,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maalox,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maalox 0,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maalox 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Macrobid 100mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Macrodantin 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Macrodantin 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mag Carb/Al Hydrox/A (Genaton),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mag Citrate 10 Fld Oz Bottle,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mag Hydrox/Aloh/Simeth(Mylanta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mag Ox 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MAG64 DR 64 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magaldrate (Ron Acid) Sus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magaldrate/Simeth Sus,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magdelay Sa 64 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magic Mouthwash,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium 250 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Chloride (Slow-Mag),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Citrate,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Citrate 8oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Gluconate 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Hydroxide (Mom) 30ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Hydroxide 1ml,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Oxide 241,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Oxide 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Oxide 600 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Sulf Sdv : 0.5gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Sulfate (Epsom Salt),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Sulfate 1gm 2ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Magnesium Sulfate/D5w 1gm Ivpb,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Malaria Smear,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Male External Cath-Medline,,,,, $2.12 , $2.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mammogram Special,,,,, $117.66 , $117.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mandelamne 1 Gm,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mandible 1-3v,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mandible Complete,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mandible Copl I/F,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mandible Limited,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mandible Min 4v,,,,, $545.90 , $545.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mannitol 25% 50ml Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Manual Differential,,,,, $623.28 , $623.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Manual Therapy 15 Min,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Manuel Diff,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maralax 1 Tbsp,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Marcaine 25mg/ML Inj,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Marinol 2.5mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Marinol 5 Mg Tab,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Masgnesium Hydroxide Sus 30ml,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask Aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mask CPAP Vinyl Disposable Sm,,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mask Face Air Cushion Adult,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask Oxy,nrb - Adult",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask, Ear Loop",,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask, Face Soft Aire",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask, Full Face Large",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask, Full Face Medium",,,,, $207.76 , $207.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask, Full Face Small",,,,, $178.08 , $178.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask, Nasal Petite",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask, Nasal Small",,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask,adult,multi-Vent,disposab",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask,aerosol,elongated,adult",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask,cpap,vinyl,disposable Med",,,,, $160.06 , $160.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask,oxy,med,conce,adlt,undchi",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask,proc,pleat,antifog,blue",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mask,tracheostomy Adult",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mastoid Complete,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mastoids Min 3v Ea Side,,,,, $492.90 , $492.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mavik 1 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maxitrol Eye Drops,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maxitrol Eyedrop 5ml (Dexameth,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maxitrol OP Oint 3.5gm,,,,, $180.00 , $180.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maxzide 50/75,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Maxzide 75/50,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mdi,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mdi Pulmicort Turbohaler,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mdi Setup,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mdi Treatment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meckels Diverticulum Scan,,,,," $1,576.22 "," $1,576.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meclizine (Antivert) 12.5mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meclizine 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meclizine 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Med Respiratory Mask,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medical Food 1 Tab,,,,, $188.00 , $188.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medihoney 44 ML Tube,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medium Disposable Sling 10 Cas,,,,, $91.16 , $91.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medrol Dose Pak,,,,, $132.00 , $132.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medroxyprogesterone 5mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medroxyprogesterone 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medroxyprogesterone A Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medroxyprogesterone A Tab : 5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medroxyprogesterone Tab : 2.5m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medseptic Packet Each,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Medseptic Skin Protectant Pkg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MEGACE 100 ML BOTTLE,,,,, $51.48 , $51.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace 240 ML Bottle,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace 40 Mg Tablet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace 400mg/10ml,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace 60 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace 80 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 105 ML,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 120 Cc Bottle,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 140 ML  Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 160 ML Bottle,,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 20 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 240 ML Bottle,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 25 Cc Bottle,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 280 Cc Bottle,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 30 ML Bottle,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 35 Cc Bottle,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 40 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 50 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 60 Cc Bottle,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 70 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 75 ML Bottle,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 80 ML Bottle,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Elixir 90ml Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Es Elixir 150 ML Bottle,,,,," $3,406.00 "," $3,406.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megace Susp. 5ml,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megestrol (Megace) 40mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MEGESTROL 20 MG,,,,, $1.68 , $1.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megestrol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MEGESTROL ACE O/SOS 40MG,,,,, $48.75 , $48.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megestrol Acetate 40 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megestrol Acetate 400mg/10ml,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megestrol Acetate Sus 625mg,,,,," $3,865.00 "," $3,865.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Megestrol Susp 400mg (40mg/ML),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Melatonin .75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MELATONIN 0.5,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Melatonin 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Melatonin 1.50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MELATONIN 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Melatonin 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Melatonin 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Melgisorb Rope 12-1/2 Inch,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meloxicam (Mobic) 7.5mg Tab,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meloxicam 15 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meloxicam 7.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MEMANTIN ER 14 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MEMANTIN HCL ER 21 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MEMANTIN HCL ER 7 MG,,,,, $17.84 , $17.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Memantine (Namenda) 5mg Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MEMANTINE ER 28 MG,,,,, $18.40 , $18.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Memantine HCL 10mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Men Phor Anti Itch Lotion,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Menthol/Zinc Oxide (Calmosepti,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meperidine (Demerol) 25mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meperidine (Demerol) 50mg Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meperidine HCL (Demerol) Amp :,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meperidine HCL (Demerol) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meperidine Mdv (Demerol Pca) V,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mephyton 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mepilex,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mepilex 4x4 Bordered Gauze,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meplix Wound Dressing,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meprobamate 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meprobamate 200 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meprobamate Tab : 400mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meprobromate 400 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mercaptopurine Tab : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mercury,,,,, $338.14 , $338.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meropenem (Merrem) 500mg Inj,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Merrem 1gm/100mls Ns,,,,, $838.00 , $838.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Merrem 250mg Ivpb,,,,, $690.00 , $690.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mesalamine (Asacol) Tab : 400m,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mesalamine (Rowasa) 1000mg Ene,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Messengile Douche,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mestinon 60mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metafolbic Plus,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metaformin 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metalozone 5 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metamucil 1 Tsp,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metamucil Cap,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metamucil Pkt,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metanephrines 24 Hr Urine,,,,, $692.18 , $692.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metanephrines Urine,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metanx 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metaxalone (Skelaxin) 800mg Ta,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metaxalone 800 Mg Tab,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin (Glucophage Xr) 500m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin (Glucophage) 500mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin (Glucophage) 850mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin 1000 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin 250 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin 600mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin 750 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin 850 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin HCL 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin HCL 850 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin HCL ER 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metformin HCL ER 500 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Meth/Me Blue/Ba/Salo (Urised),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methadone,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methadone 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methadone 2.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methadone 20 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methadone 5 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methadone HCL 10mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methazolamide Tab : 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methenamine Hippurat Tab : 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,METHENAMINE HIPPURATE TAB,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methenamine Mandelate 1 Gm,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,METHENAMINE MD 500 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methergine Amp : 0.2mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methimazole Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methlphenidate 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methocarbamol (Robaxin) 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methocarbamol 500 Mg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methocarbamol 750 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methotrexate 10 ML Vial,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methotrexate 15 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methotrexate 2 ML Vial,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methotrexate 2.5mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methotrexate 25mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methotrexate Sod Vl : 50mg/2ml,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methyldopa (Aldomet) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methyldopa/Hctz Tab : 250/15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methyldopate (Aldomet) 250mg/5,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylene Blue Vl : 0.01,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylmalonic Acid,,,,, $346.00 , $346.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylmalonic Acid Sine Ea Sp,,,,, $728.22 , $728.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylphenidate (Ritalin) 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylphenidate 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylphenidate 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylpred Na Succ (Solu Medro,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone (Depo Medro,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone (Medrol Dos,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone (Medrol) Ta,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone (Solu-Medro,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone 125mg/2ml,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone 2 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone 4 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone Ac Sdv : 40,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone Vl : 62.5mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisolone(Solu-Medrol,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisone 80 Inj,,,,, $191.00 , $191.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Methylprednisone Inj 40 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metipranolol Sol : 0.03,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoclopramide (Reglan) 10mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoclopramide (Reglan) 10mg/2,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoclopramide 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoclopramide 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoclopramide Syr : 1mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoclopramide Syrup 140 ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metolazone (Zaroxolyn) 2.5mg T,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metolazone 2.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metolazone 5 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metopolol Succer 50 Mg ER,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol (Lopressor) 50mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol (Lopressor) 5mg/5ml,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol 100 mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol 12.5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol 6.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol ER 200 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Succ,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Succ ER 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Succ ER 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Succ Sr 100,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Succinat (Toprol Xl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Tar 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Tart 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Tart 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Tartate 150mg,,,,, $7.50 , $7.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Tartate 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Tartrate Tab : 100m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Tartrate Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Xl 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metoprolol Xl 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metronidazole (Flagyl) 250mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metronidazole 0.75% (appl),,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metronidazole 0.75% (tube),,,,, $165.70 , $165.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metronidazole 250mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metronidazole 500mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metronidazole 75% Cream 45 Gm,,,,," $1,011.00 "," $1,011.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Metronidazole/Nacl (Flagyl IV),,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mevacor 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mexiletine (Mexitil) Cap : 150,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mexiletine Cap : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mexiletine HCL 150 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mhatp,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miacalcin 200 U Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miacalcin Nasal Spray 3.7,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miacalin 200u Dose,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mi-Acid Gas,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Micafungin (Mycamine) 100mg In,,,,," $1,192.00 "," $1,192.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Micardis 40 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Micardis 80 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miconazole (Monistat) Cream,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miconazole (Monistat-7) Cream,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miconazole (Zeasorb-Af) Powder,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miconazole Nitrate 2% Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miconazole Nitrate Sup : 100mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miconazole Vag Supp (Monistat),,,,, $234.00 , $234.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Microalbumin,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Microalbumin Urine,,,,, $283.02 , $283.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Microfib Collagen (Avitene) Pw,,,,, $462.00 , $462.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Micro-K 8 Meq Extenca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midazolam (Versed) 2mg/2ml Vl,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midazolam (Versed) 5mg/ML Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midazolam Syr : 2mg/ML,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midodrine (Proamatine) 5mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midodrine 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midodrine 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midodrine HCL 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midodrine HCL Tab : 10mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midorine HCL 5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Midrin Capsules,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Migrazone Capsules,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Milacalcin 3.7 ML Bottle,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Milk of Magnesia 10 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Milk of Magnesia 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Milk of Magnesia 30 Cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Milrinone (Primacor) 20mg/100m,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Milrinone (Primicor) 10mg Vial,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MINERAL OIL 16 OZ BOTTLE,,,,, $20.68 , $20.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mineral Oil 30 Cc,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mineral Oil 30 ML Bottle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mineral Oil Light (Muri-Lube),,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mineral Oil Usp (Fleet Miner),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Minipress 1 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Minocin 100mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Minocycline (Minocin) 50mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Minocycline 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Minoxidil (Loniten) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Minoxidil 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Minoxidil 2.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Minoxidil Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miochol E Sol : 0.01,,,,, $250.00 , $250.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miralax 17 Gm Pkt,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miralax Packet,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Miralex 255 Gm,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirapex .125 Mg Tab,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirapex 0.025 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirapex 0.25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirapex 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirapex 1 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirapex 1.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirtazapine (Remeron) 15mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirtazapine 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirtazapine 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirtazapine 45 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mirtazapine 7.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Misc Chem/Tox,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Misc Immun Proc,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Misoprostol (Cytotec) Tab : 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Misoprostol 100 Mcg,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Misoprostol 200 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mitochondrial Antibody,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mivacurium Inj 2mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Moban 25 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Moban 50 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mobic 15 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mobic 7.5 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Modafinil (Provigil) 100mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Modafinil 200 Mg,,,,, $47.00 , $47.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Modurectic 5/50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Moexipril  (Univasc) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Moexpril HCL 15mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mometasone (Asmanex) Inhaler,,,,, $635.00 , $635.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mometasone (Elocon) Cream,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mometasone (Nasonex) Nasal Spr,,,,, $478.00 , $478.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mometasone 0.1% Cream 15 Gr,,,,, $226.00 , $226.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Monistat 7 Vag Supp,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Monistat Vaginal Cream 2%,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mono Test,,,,, $147.34 , $147.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Monopril 20mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Monopril 5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Montelukast (Singulair) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Montelukast 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Moricizine HCL (Ethmozine) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morph Sulf 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine 0.3 Mg Inject,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine 10mg/ML Amp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine 15 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine 2mg/1ml Inj,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine Cr 30 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine ER (Ms Contin) 15mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine Injection 8mg/1ml,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine Ir 15mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine So4 (Roxanol) Sol : 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine Sulf 15 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine Sulf ER 30,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MORPHINE SULF ER 60 MG,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine Sulfate Pca 1mg/ML 50,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphine Sulfate Sup : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Morphology,,,,, $520.46 , $520.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Motrin 120ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Motrin 600mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Motrin Susp 5ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Mouthpiece, Oneway,disposable",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mouthwash,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mouthwash 4oz Alcohol-Free Gss,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MOVANTIK 25 MG,,,,, $51.24 , $51.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MOVE FREE ULTRA,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Moxifloxacin (Avelox IV) 400mg,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Moxifloxacin (Avelox) 400mg Ta,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Moxifloxacin (Vigamox) 0.5% OP,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mra Head Wo Cont,,,,," $1,312.28 "," $1,312.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mra Neck Wo Cont,,,,," $1,906.94 "," $1,906.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Abd W/&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Abd W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Abd Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Add'l Levels,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Bone Marrow Blood Sup,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Brain W&wo Cont,,,,," $4,325.86 "," $4,325.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Brain W/Cont,,,,," $5,235.34 "," $5,235.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Brain Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Chest Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI C-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI C-Spine W/ Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI C-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Head,,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Low Extrem Jt W/Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Low Extrem Jt Wo Cont,,,,," $3,757.70 "," $3,757.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Low Extrem Jt Wo Cont Bil,,,,," $7,515.40 "," $7,515.40 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Low Extrem W&wd Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Low Extrem Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI L-Spine W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI L-Spine W/Cont,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI L-Spine Wo Cont,,,,," $3,606.12 "," $3,606.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Myocardium Morphology,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Orb/Face/Nect Wo Cont,,,,," $6,315.48 "," $6,315.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Pelvis W&wo Cont,,,,," $6,630.30 "," $6,630.30 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Pelvis Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"MRI Shoulder, Upr Ext Joint",,,,," $3,007.00 "," $3,007.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI T-Spine W&wo Cont,,,,," $14,057.72 "," $14,057.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI T-Spine Wo Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Up Extrem Jt Wo Cont,,,,," $4,867.52 "," $4,867.52 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Up Extrem W&wo Cont,,,,," $6,631.36 "," $6,631.36 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MRI Up Extrem W/Cont,,,,," $4,862.22 "," $4,862.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ms Contin 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mslt,,,,," $4,470.02 "," $4,470.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mth/Me Blu/Sal/Na (Urogesic Bl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucin Synovial Fluid,,,,, $104.94 , $104.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucinex 1200 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucinex 20mg Syrup,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucinex 600 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucinex D,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucomyst 10% 30ml Bottle,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucomyst 20 % Each Vial,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucomyst 20% 10cc Bottle,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mucus ER 12 Hr Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mulidex Wound Gel 3oz,,,,, $131.44 , $131.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multaq 400 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MULTIGEN CAP 90,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multigen Plus Caplet,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MULTILEX,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multiple Sleep Latency Testing,,,,, $917.96 , $917.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multivit/Min Elixir (Eldertoni,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multivitamin (Mvi) 10ml Vl,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multivitamin (Mvi) Liquid 4oz,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multivitamin Prep (Dexfol) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multivitamin With Min (Thera M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multivitamin With Mineral,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Multivitimine,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mumps Antibody,,,,, $765.32 , $765.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mupirocin (Bactroban) 2% Oint,,,,, $223.00 , $223.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mupirocin 2% Ointment,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Murine Tears Plus,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Muro 128 Eye Drops,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mvi Elixir 5 Cc,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mvp,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mybetriq 25 mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mycobacteria Tb Apt,,,,, $884.04 , $884.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mycobacterum Pcr Test,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mycolog Ii Cream 30 Gm Tube,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mycophenolate (Myfortic) 360mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MYCOPHENOLATE 250 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MYCOPHENOLATE 500 MG,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mycoplasma Latex Antibody,,,,, $726.10 , $726.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mycostatin Cream 15gm,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myelin Assoc Glycoprot,,,,, $603.14 , $603.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myelin Basic Protein Csf,,,,, $523.64 , $523.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myelogram Cervical S&i,,,,," $2,428.46 "," $2,428.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myelogram Complete Spine S&i,,,,," $2,308.00 "," $2,308.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myelogram Lumbar S&i,,,,," $2,134.84 "," $2,134.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myelogram Thoracic S&i,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mylanta 15ml,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mylanta 30 Cc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mylanta 30ml  (bottle),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mylanta 30ml (dose),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mylanta Bottle,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mylicon 125 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mylicon 80,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myo Perf Img Single/Spec W&wo,,,,," $5,828.94 "," $5,828.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myo Perf Img/Mult W&w/O Phar,,,,," $3,110.04 "," $3,110.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myo Perf Img/Single Study,,,,," $1,555.02 "," $1,555.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myo Perf Study/Wall Mot,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myo Perf W/Eject Fract,,,,, $458.98 , $458.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myo Perfimg Single/Spect,,,,," $2,698.76 "," $2,698.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myocardial Img Infarct Avid,,,,," $1,522.16 "," $1,522.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myoglobin,,,,, $100.70 , $100.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myoglobin Urine,,,,, $497.14 , $497.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mypirocin Oint 2% 15 Gm Tube,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,MYRBETRIQ ER 25 MG,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Myrbetriq ER 50 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Mysoline 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Na Phos/K Phos (Neutra-Phos) P,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nabumetone 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nabumetone 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,N-Acetyl Cysteine 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nacl .9% 250ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nacl 0.45%/Kcl 20meq 1000ml Ba,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nacl 3% (Hypertonic Saline) 50,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nacl 4 Meq/ML 250 ML,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nacl 4 Meq/ML 250ml,,,,, $266.00 , $266.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nacl Irrig 15 ML,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nacl/Gly/Lan/Mo/Pet (Lubriderm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nadolol 20 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nadolol 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nafcillin (Nafcil) 1gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nafcillin (Nafcil) 2gm Inj,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nafcillin 2gm/100mls,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nail File,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nail Polish Removwer Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nalbuphine (Nubain) 10mg Amp,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nalfon 400 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naloxone (Narcan) 0.4mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naltrexone 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Namenda 10mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Namenda 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Namenda Xr 14 Mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Namenda Xr 21 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Namenda Xr 28 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Namenda Xr 7 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NAMZARIC 14/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NAMZARIC 28/10 MG,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NAPCON A SOL,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naphazoline (Clear Eyes) 0.012,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naphazoline HCL Ophth Sol 0.1%,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naphazoline/Pheniram (Visine A,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naphcon-A 5ml,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NAPHCON-A EYE DRP 30 ML,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naprelan 375 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naprosyn 250 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naprosyn 375 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naprosyn 500mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen (Naprosyn) 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen 250 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen 375 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen 500 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen 550 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen Ec Tab : 375mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen Ec Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen Sod,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Naproxen Sodium (Aleve) 220mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Narcan 0.4 Mg Im,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Narco 10/325,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Narco 5/325 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasacort Aq,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasal Airway 26fr Latex #88882,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasal Bone 3 Views,,,,, $457.00 , $457.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasal Bones Min 3v,,,,, $414.46 , $414.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasal Bones Only,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasal Cannula,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasal Crom Spray,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasal Decongestant Pe 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasal Solutions,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasalcrom 4% Spray,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasogastric Feeding Tube Dobb,,,,, $79.84 , $79.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasogastric Sump 16fr,,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nasonex Nasal Spray,,,,, $557.00 , $557.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nateglinide 120 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nateglinide 60 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NATURAL BALANCE TEARS,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nature Tear Drops,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nauzene,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Navane 5 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nb Valerian Root,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nbc Cream 50 Mg Tab,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NBL BALANCE B 100 TAB,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebivolol (Bystolic) 5mg Tab,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebivolol 10mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebulizer,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebulizer Lg Volume H20 760ml,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Nebulizer Micromis Sm Vol 7""",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebulizer Var Flow Misty Ox,,,,, $40.28 , $40.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebulizer W/ Mouthpiece,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebulizer W/Add Meds,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebulizer W/Mask,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nebupent (Pentamidine) Inh : 3,,,,, $515.00 , $515.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neck Soft Tissue,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nedocromil (Alocril) 2% Ophth,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Needle,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Needle 18x1 100/Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Needle 21x1 Tw Safe Eclip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Needle Hypo Eclipse 21gx1""",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Needle Hypodermic 18gx1 1/2in,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Needle Safey 18g 1.5"" Surgrd",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Needle Wingset Bcs 23x.75 12,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Needle, 22 Gauge X 1  Cricket",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nefazodone (Serzone) 50mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nefazodone 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neo/Bacit/Poly (Triple Anti) O,,,,, $82.00 , $82.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neo/Poly/Sulf/Dex Oin,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neo/Polymyxin/Hc Ear 10ml,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neom/Poly B/Hc Sus : 0/S,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neomy/Poly/ Hc Otic Sol,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neomycin Sulfate Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neomycin/Dexameth Pho (Neo-Dec,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neomycin/Poly/Bacitr (Neospori,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neomycin/Poly/Hc (Cortisporin),,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neomycin/Polymyx/Bac (Triple A,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neomycin/Polymyxin B Amp,,,,, $92.00 , $92.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neomycin/Polyumyxine Ba,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neosporin,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neosporin Ung Pk,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neostigmine Methylsu (Neostigm,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nephrocap 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nephrocaps (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nephrostogram,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nephrostomy Perc Bi S&i,,,,," $1,580.46 "," $1,580.46 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nepro Nutrition 8 Oz Bottle,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nep-Synephrine 1%,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nesiritide (Natrecor) 1.5mg Vl,,,,," $3,134.00 "," $3,134.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NEUDEXTA CAP 20-10 MG,,,,, $68.96 , $68.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neupro Patch 1 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NEUPRO PATCH 2 MG,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neupro Patch 6 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neurontin 10 Cc Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neurontin 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neurontin 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neurontin 300 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neurontin 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neurontin 600 Mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neurontin 800mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neurontin 900 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neutra Phos K Pkts,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neutro Phos 250mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Neutrophil Ab,,,,, $267.12 , $267.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nexium 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nexium 40 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Niacin 250 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Niacin 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Niacin 500 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Niacin 500mg Cr Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Niacin Level,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Niaspin 1,000 Mg",,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicardipine Cap : 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicardipine Sr (Cardene) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicoderm Patch 21mg,,,,, $150.00 , $150.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine,,,,, $243.80 , $243.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine (Nicorette) 2mg Gum,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine (Nicotrol) 14mg Patch,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine (Nicotrol) 21mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine (Nicotrol) 7mg Patch,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine (Nicotrol) System,,,,," $1,073.00 "," $1,073.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine Lozenges 2 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine Patch 14mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine Patch 21 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine Patch 7 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nicotine Transdermal,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nifediac Cc 60 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nifedipine (Procardia Xl) 30mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nifedipine 15 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nifedipine 60mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nifedipine Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nifedipine ER 30 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nifedipine ER 60mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nifedipine ER 90 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Niferex 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nilandon 150 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nilutamide (Nilandron) Tab : 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nimodipine (Nimotop) Cap : 30m,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nirovam 0.25 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nisoldipine (Sular) 10mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nisoldipine (Sular) Tab : 30mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nisoldipine 20mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nito-Bid Pk Ont : 0.02,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitro Dur 0.4mg,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitro Dur Trans 0.3 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitro Tab 0.4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitro Transderm 0.2 M,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitro Transderm 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrobid Oin 60 Gm,,,,, $253.00 , $253.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrobid Oint 2% 3gr Tube,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrofurantoin (Furadantin)25m,,,,," $2,090.00 "," $2,090.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrofurantoin (Macrobid) 100m,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrofurantoin 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrofurantoin MAC 100,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrofurantoin Mono. 100mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrofurantoin(Macrodantin)50m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrofurantoin/Nitro 100,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrofurantoin-Macro 7,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin (Nitro-Bid) 2% O,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin (Nitroquick) 0.4,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Cap : 2.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Ointment,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Ointment 2%,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Patch 0.4,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Patch T 0.2,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Sa Cap : 6.5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Spy : 0.4mg,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin ST 6.5,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Sub Tab 0.4mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin Transde (Nitro-D,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroglycerin-D5w 25mg/250ml (,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrogylcerin (Nitro-Dur) Pat,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrogylcerin Pat : 0.4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrolingual Spray,,,,, $487.00 , $487.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrolingual Spy : 0.4mg,,,,, $510.00 , $510.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitropaste 0.4 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitropaste 60 Gram Tube,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroprusside Sod (Nitropress),,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitroquick,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nitrostat 0.4mg/25,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nizatidine 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nizoral Shampoo,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,No Rinse Shampoo,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nolvadex 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nolvadex 20 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Non Adherent Pads,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Non Rebreather,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nonconductive Connect Tubng 72,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Noratriptyline,,,,, $454.74 , $454.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norco 10/325 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norco 325/7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norco 5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norcuron,,,,, $886.00 , $886.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norepinephrine (Levophed) 4mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norethin/Ethinyl (Femhrt) Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norflex 100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Normal Saline 100 Precedex 200,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Normal Saline 45% 1000 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norpramin 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nortiptyline HCL Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nortriptyline 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nortriptyline 75 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nortriptyline Cap : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NORTRIPTYLINE HCL 10 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norvasac 5mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norvasc 10mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norvasc 2.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norvasc 5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Norvir Liquid 240ml Bottle,,,,," $2,522.00 "," $2,522.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin 100units,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin 70/30,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin 70/30 10ml Bottle,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NOVOLIN 70/30 EACH UNIT,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin 70/30 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin N 100/U/ML,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin Nph Each Unit,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin R 100 Units,,,,, $271.00 , $271.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin R 100 Units/ML,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin R Inj 100 Units,,,,, $501.00 , $501.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolin R Insulin Each Unit,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolog,,,,," $2,822.00 "," $2,822.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolog Each Unit,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolog Flexpen,,,,," $1,617.00 "," $1,617.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Novolog Mix 70/30,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns (Nalc) 1000ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns 0.45% 1000ml Bag,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns 0.9% Bacteriostatic 30ml Vl,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns 1000ml Bag,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns 100ml Bag,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns 250ml Adv Bag,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns 250ml Bag,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns 250ml Glass Bottle,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns 50ml Bag,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns Flush 10ml Syringe,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns Irrigation 3000ml,,,,, $259.00 , $259.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns Plus 100ml Bag,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns Plus 50ml Bag,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ns/Kcl 20meq 1000ml Bag,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuclear Mol/Diag Enz/Dig,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuclear Mol/Diag Interp,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuclear Mol/Diag Iso/Ext,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuclear Mol/Diag Nap Ea,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuclear Mol/Diag Pcr,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuclear Mol/Diag Rt,,,,, $223.66 , $223.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nucleotidase 5,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuedexta 10/5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuedexta 20/10,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuplazid 34 mg,,,,, $304.74 , $304.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nursing Assessment,,,,, $500.00 , $500.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrashield Skin Crème,,,,, $26.08 , $26.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Beneprotein,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Ensure Enlive,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Ensure Plus,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Glucerna 1.4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Isosource,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Jevity,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Juven,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Nepro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Oxepa,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Prostat,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Twocal Hn,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nutrient-Vital 1.5,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuvigil 125 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuvigil 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuvigil 250 Mg,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuvigil 50 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nuvigil 75 Mg,,,,, $127.00 , $127.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NYSTA/BACTRO/CALMO CREAM,,,,, $193.00 , $193.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin (Nystop) Powder 15gm,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin 1 ML Sus,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin 100 Ky Pwd,,,,, $375.00 , $375.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Nystatin 500,000 Units/5ml Ud",,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Cream 100 Units,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Cream 15gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Cream 30 G Tube,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Mouthwash 5 Cc,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Oral Susp 75ml,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Powder 15 Gms,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Powder 30 Gms,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Powder 60 Gms,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NYSTATIN S&S 105 ML BOTTLE,,,,, $79.76 , $79.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin S&s 120 ML Bottle,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin S&s 140 ML Bottle,,,,, $307.00 , $307.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin S&s 180 ML Bottle,,,,, $161.00 , $161.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NYSTATIN S&S 280 ML BOTTLE,,,,, $131.60 , $131.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,NYSTATIN S&S 30 ML BOTTLE,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin S&s 60ml Bottle,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin S&s 70 ML Bottle,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Swish&swallow 270 ML,,,,, $319.00 , $319.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin Swish&swallow 75 Cc,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin/Lidocain Mw 100 ML Bo,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin/Triamcinol 30 Gm Tube,,,,, $626.00 , $626.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin/Triamcinolone (Mycolo,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Nystatin/Triamcinolone 30mg,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,O2 Concentrator,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ob Screen,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Occult Blood,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Occult Blood Gastric,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Occult Blood Stool,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Occuvite,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ocean Mist,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ocean Nasal Spray,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ocean Sol 0.65% Spray,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ocean Spray,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ocortison Acetate Rectal Suppo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Octreotide (Sandostatin) 100mc,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Octreotide Acetate (Sandostati,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Odor Eliminator Scented,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ofloxacin 0.3% Gtt 5ml Bottle,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ofloxacin Otic Sol : 0.003,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ogen 1.25 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oil Emulsion Non Adh Dressing,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ointment 120 Com,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine (Zyprexa) 10mg Inj,,,,, $142.00 , $142.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine (Zyprexa) 5mg Tab,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine (Zyprexa) Tab : 10m,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine (Zyprexa) Tab : 2.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 0.5 Mg Im,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 10mg Im,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 12.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 15 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 2.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 20 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 5mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine 7.5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olanzapine/Fluoxetin (Symbyax),,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oligoclonal Bands,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olmesartan (Benicar) 20mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olmesartan Med (Benicar) Tab :,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OLMESARTAN MEDOXOMIL 20 MG,,,,, $3.64 , $3.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olmesartan Medoxomil 40,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Olopatadine (Patanol) 0.1% Eye,,,,, $449.00 , $449.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OLOPATADINE HCL 0.2% EYE DROPS,,,,, $195.80 , $195.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OLOPATADINE OPTH 1%,,,,, $166.00 , $166.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Omacor 1 Gm,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OMEGA 3 ETHYL ESTERS 1 GM,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Omega 3fa 1000mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Omega-3 Fish Oil,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Omeprazole 10mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Omeprazole 20mg Caps,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Omeprazole 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Omnicef 300mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ondansetron (Zofran) 4mg Inj,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ondansetron 450 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ondansetron 4mg/20ml Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ondansetron 8 Mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ondansetron HCL (Zofran) Tab :,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ondansetron HCL 4 Mg,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ondansetron Odt 4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,One A Day,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,One A Day Weight Smart Vit,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,One-A-Day Mens,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Onfi 10 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Onglyza 5 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Opana ER 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Opcon A Eye Drops,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Opiates Quantitative,,,,, $278.78 , $278.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oprelvekin (Neumega) Vl : 5mg,,,,," $1,599.00 "," $1,599.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Optic Foramina Exam,,,,, $690.06 , $690.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Optifoam Sacrum Dress 6x6.5,,,,, $37.10 , $37.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Optimum Protein Powder/Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Optivar 0.05% Eye Drps,,,,, $434.00 , $434.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Optive Eye Drops,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orabase-B 20% Paste,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orajel,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ORAJEL LIQUID 45 OZ,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oral Care Kit,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oral Care Kit Biotene,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orap 1 MG,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orap 2 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orbit X-Ray,,,,, $318.00 , $318.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orbits 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orbits 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orbits/Sinus Lmtd,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orphenadrine (Norflex) 100mg T,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orphenadrine (Norflex) Amp : 3,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orphenadrine ER 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Orthosis, Freedom Omni",,,,, $460.04 , $460.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Orthotic Fit Train 15min,,,,, $175.00 , $175.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Os Cal 250 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Os Cal 500 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Os Cal 500 Mg+d,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Os Cal 500d,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Os Cal 600 Mg + D,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Os Calcis,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Os Calcis 2 Views I/F,,,,, $202.00 , $202.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oseltamivir (Tamiflu) 75mg Cap,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oseltamivir Phospate (Tamiflu),,,,, $220.00 , $220.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Osmolality Blood,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Osmolality Urine,,,,, $274.54 , $274.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Osphena 60 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Osteo Bi Flex,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Osteo Bi Flex 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Osullivan,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Adl 15-Min,,,,, $182.00 , $182.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Appl Finger Slint Dynamic -,,,,, $240.00 , $240.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Appl Finger Splint Static -,,,,, $219.00 , $219.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Appl Longarm Splint Static,,,,, $407.00 , $407.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Appl Shortarm Splint Dynami,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Appl Shortarm Splint Static,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Cognitive Train 15-Min - Go,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Estim Man 15-Min - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Evaluation/-Go,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Gait Training 15-Min - Go,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Hot/Cold Packs - Go,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Manual Therapy - Go,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Massage 15-Min - Go,,,,, $165.00 , $165.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Muscle Tst Ext/Trnk/Rpt - G,,,,, $282.00 , $282.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Muscle Tst Hand W/Rpt - Go,,,,, $325.00 , $325.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Neuro Re-Ed 15-Min - Go,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Ortho/Pros Checkout Ext 15-,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Orthotic Mgmt 15-Min - Go,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Re-Eval - Go,,,,, $211.00 , $211.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Tens Application - Go,,,,, $206.00 , $206.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Therapeutic Activity 15-Min,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Therapeutic Ex 15-Min - Go,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OT Traction Mechanical - Go,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ova and Parasites,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ova Paras Smears,,,,, $83.00 , $83.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ova Parasites Ocp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxaliplatin (Eloxatin) Vl : 0.,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxandrin 2 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxandrolone (Oxandrin) 2.5mg T,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxandrolone 2.5mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxazepam Cap : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxazepam Cap : 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxcarbazepine (Trileptal) Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxcarbazepine 150mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxcarbazepine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxcarbazepine 600 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,OXCARBAZEPINE 75 MG,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxybutynin (Ditropan Xl) 5mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxybutynin (Ditropan) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxybutynin 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxybutynin 15 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxybutynin 3.9 Mg Patch,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxybutynin Choloride 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxybutynin Sa Osm 5mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone (Oxycontin) 10mg Tab,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone (Oxycontin) 20mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone (Oxycontin) 40mg Tab,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone (Percolone) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone 15 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone 20mg Tab,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone 5 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone 5/500,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone HCL 40 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone HCL Sr 12hr 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone/Apap (Percocet) Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone/Apap 10/325 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone/Apap 2.5/162.5 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone/Apap 5/325 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycodone/Apap 7.5/325 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxycontin 80 Mg Tab,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxygen Continuous/Hour,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxygen Daily Maintenance,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxygen Mask,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxygen Per Day,,,,, $359.00 , $359.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxygen Setup,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxygen Standby/Daily,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxymetazoline HCL (Nasal Decon,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxytocin (Pitocin) Vl : 10un,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxytrol Patch,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oxytrol Transderm Patch 3.9mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oyster Shell Calcium,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Oyster Shell Calcium 500 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pacemaker Inst/Fluor 1hr,,,,," $1,639.82 "," $1,639.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paceron 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paceron 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Pack, Basic",,,,, $29.68 , $29.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pad Prep Chlorascrub 1ml,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Pad,abdominal,curity 5x9 Steri",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Pad,prep,chlorascrub 1ml",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pain Reliever Tab 325mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PALIPERIDONE ER 1.5 MG,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PALIPERIDONE ER 3 MG,,,,, $58.20 , $58.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PALIPERIDONE ER 6 MG,,,,, $55.56 , $55.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Palm Cups 60mm,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Palm Grip,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pamelor 50 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pamelor 75 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pamidronate Vl : 30mg,,,,," $1,524.00 "," $1,524.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pancrease Ec Caps,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pancrelipase (Creon-10) Cap :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pancrelipase 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pancuronium Vl : 2mg/ML,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pangestyme Ec,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Panorex,,,,, $302.00 , $302.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pantoprazole (Protonix IV) 40m,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pantoprazole (Protonix) 40mg P,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pantoprazole (Protonix) 40mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pantoprazole 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pantoprazole 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pantothenic Acid (Vitamin B5),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pantroprazol 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paoxetine HCL 40mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Papain/Urea (Kovia) Ont,,,,, $260.00 , $260.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Papaverine HCL Sa (Pavabid) Ca,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Papaverine HCL Vl : 30mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paper Tape,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Papin/Urea/Chlorphy (Ziox) Ont,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Parathyroid Hormone,,,,, $422.94 , $422.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Parathyroid Hormone-Reltd Pptd,,,,, $409.16 , $409.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Parathyroid Scan,,,,," $1,275.18 "," $1,275.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Parcopa 25/100 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paregoric Liq : 2mg/5ml,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paricalcitol (Zemplar) 1mcg Ca,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paricalcitol (Zemplar) 5mcg In,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paricalcitol 2 Mg,,,,, $102.00 , $102.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Parlodel 2.5 Mg,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetin HCL 5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetine (Paxil) 10mg/5ml Su,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetine (Paxil) 20mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetine 40 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetine HCL 10mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetine HCL 20 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetine HCL 30 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetine HCL Sr 24h,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paroxetine Sr (Paxil Cr) 12.5m,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Parvo Virus Igg,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Parvo Virus Igm,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Passy Muir Valve,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pataday 2% (bottle),,,,, $594.00 , $594.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pataday 2% (drop),,,,, $19.80 , $19.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pataday Eye Drops,,,,, $662.00 , $662.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Patanase Nasal Spray,,,,, $535.00 , $535.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Patanol,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Patanol 0.12% Eye Drps,,,,, $774.00 , $774.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Patanol Opth Soln 0.1% 5ml,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pathology Consult In Surg,,,,, $815.14 , $815.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pathology Level I,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pathology Level Ii,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pathology Level Iii,,,,, $279.84 , $279.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pathology Level IV,,,,, $313.76 , $313.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pathology Level V,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pathology Level Vi,,,,, $617.98 , $617.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Patient Education,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Patient Education Group Sessio,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil 20 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil 30 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil 5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil Cr 12.5,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil Cr 25 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Paxil Mcr 37.5,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PAZEO 0.7% EYE DROPS,,,,, $787.00 , $787.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pc Tar 6 Oz. Shampoo,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PCA Extension Set Minibore,,,,, $40.64 , $40.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pcr Amplification,,,,, $253.34 , $253.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peak Flow,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Peak Flowmeter, Truzone",,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pedialyte 8 Oz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peg Dressing Change,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peg Electrolyte (Golytely) Sol,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peg Tube Placement,,,,," $1,585.76 "," $1,585.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pegfilgrastim (Neulasta) Pfs :,,,,," $8,933.00 "," $8,933.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pehnytoin Na Extended 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pelvimetry,,,,, $520.00 , $520.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pelvis 1 or 2 Views,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pelvis 2 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pelvis Min 3 Views,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pen V Pot Ov 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Penciclovir (Denavir) Crm : 0.,,,,, $176.00 , $176.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pencillin Oral Sol : 50mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Penicillin G Benz/Pr (Bicillin,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Penicillin G Benzath (Bicillin,,,,," $1,999.00 "," $1,999.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Penicillin G Potassium 5mmu Vi,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Penicillin Vk 250mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Penicillin Vk 500 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pentasa 250mg Capsule,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pentasa 500 MG,,,,, $29.32 , $29.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pentazocin Apap 25/650 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pentazocine Nalox,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pentazocine/Apap (Talacan) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pentazocine/Naloxone (Talwin N,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pentosan Polysufate (Elmiron),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pentoxifyllin 400mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pepcid  Complete,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pepcid 10 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pepcid 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,P-Ephed HCL/Hydrocod (Coldcoug,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pepto Bismol 30 Cc,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perc Placement Gi Tube,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perc Vertebroplsty Per Vrt S&i,,,,," $1,297.44 "," $1,297.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Percocet 10/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Percocet 2.5/162.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Percocet 3.75/162.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Percocet 3.75/250,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Percocet 5/162.50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Percocet 5/325,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Percocet 7.5/325 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perfusion 1 Hour,,,,, $369.94 , $369.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peri Colace,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Periactin 2 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Periactin 4 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pericardiocentesis Initial,,,,," $3,402.60 "," $3,402.60 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pericardiocentesis/Cono S&i,,,,," $2,186.78 "," $2,186.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peridex 473ml Sol,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peridex Elixir 473 ML Bottle,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perineal Cleaner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Periph Blood Smear Inter,,,,, $177.02 , $177.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PERIPH INSERT CENT CATH 4 FR,,,,," $2,713.00 "," $2,713.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peripheral Stent Plcmnt CPT,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peripheral Thrombolysis,,,,," $1,904.82 "," $1,904.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peritoneal Dialysis,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Peritoneocentesis Adb Ini CPT,,,,, $864.96 , $864.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Permethrin (Elimite) 5% Cream,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perparation-H Ointment,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perphen/Amitr (Triavil) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perphenazine,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perphenazine (Trilafon) 4mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perphenazine 16 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perphenazine 2 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Perphenazine 4 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Personal Belonging Bag,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pertussis Smears,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Petrolatum (Elta) Cream,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Petrolatum White Oin,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Petrolatum/Min Oil (Lubrifresh,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Petrolatum/Min Oil (Puralube),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Petroleum Gauze,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pflex Muscle Trainer,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pft Pre & Post,,,,, $228.00 , $228.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pft Simple,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ph Body Fluid,,,,, $102.82 , $102.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phazyme 180 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phelebotomy Theraputi,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenazopyrdidine (Pyridium) 10,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenazopyridine 100 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenazopyridine 200 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenazopyridine HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenazopyrodome 100m,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan  25mg/1cc,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan 12.5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan 12.5 Mg Im,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan 25 Mg Tab,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan 25 Mg Vial,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan 6.25 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan Elixir 60 ML Bottle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan Supp,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenergan W Codine,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarb 30 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital,,,,, $333.90 , $333.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital 15mg Pd,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital 30mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital 32.4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital 60mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital 64.8 mg,,,,, $3.75 , $3.75 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital 65mg Inj,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital Elixir 70 ML Bot,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital Elx : 20mg/5ml,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbital Tab : 97.2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenobarbitol 64.8 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenol/Methol (Cepastat) Loz,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenol/Sodium Phenol (Chlorase,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenol-Alcohol (Chloraseptic),,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phentermine 37.5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phentolamine (Regitine) 5mg Vl,,,,, $203.00 , $203.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenylephrine (Neo-Synephrine),,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenylephrine HCL Drp : 0.025,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenylephrine Ophth Sol 10% :,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenylprop/Cpm/Me-Sc (Nacon) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytek 300mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin (Dilantin) 100mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin (Dilantin) 100mg Inj,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin (Dilantin) 100mg/4ml,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin (Dilantin) 50mg Infa,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin 125mg/5 M237,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin 200 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin 237 ML Bottle,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PHENYTOIN 25 MG,,,,, $3.24 , $3.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin 50mg Chewable,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin ER 100 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin Free,,,,, $536.36 , $536.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phenytoin/Dilantin,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phoslo 667mg Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PHOSPHA 250 NEUTRAL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phosphatase Acid Total,,,,, $198.22 , $198.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phosphatydylglycerol,,,,, $696.42 , $696.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phosphorus 24hr Urine,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phosphorus Serum,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Physical Ther. Activities,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Physical Therapy Eval 30 Min,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Physical Therapy Procedures,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phytonadione (Vit K) 10mg Amp,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phytonadione (Vit K) 1mg Amp,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phytonadione (Vit K) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Phytoplex N/Rense 8oz cleanser,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Picc Line Insertion,,,,," $2,855.64 "," $2,855.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pillow Disposable 18x24 Med Wt,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Pillow,disp, 18x24 Med Wt 1st",,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pilocarpine 2% Opth Sol,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pimecrolimus (Elidel) Cre : 0.,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pindolol 10 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pindolol Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pinworm Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pioglitazone (Actos) 15mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pioglitazone 30mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pioglitazone 45mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pioglitazone HCL 15 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Piperacillin/Tazobac (Zosyn) 2,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Piperacillin/Tazobac (Zosyn) 4,,,,, $153.00 , $153.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Piperaci-Taz(Zosyn 3.375) Ivpb,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Piroxicam 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Piroxicam 19 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Placement Perc Ivc Filter S&i,,,,," $3,047.00 "," $3,047.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plagic 4 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plaquenil 200mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plasbumin 20 25% 50ml,,,,, $412.00 , $412.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plasma Volumne Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plastic One-Way Stopcock,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Aggregation,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Antibody,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Cnt,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Count Auto,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Countaiuid,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Countimanual,,,,, $146.28 , $146.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Function Assay #1,,,,, $156.88 , $156.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Neutralization,,,,, $306.34 , $306.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Platelet Pheresis Processing,,,,," $1,968.42 "," $1,968.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plavix 40 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plavix 75mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plendil 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plendil 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pletac 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pletal 100mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ployethylene Glycol,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plum Set Prim Cnvrtbl-Cardinal,,,,, $47.70 , $47.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Plurex Biomedial Drainage Kit,,,,, $436.72 , $436.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pneumococc Vaccine (Pnuemovax),,,,, $435.00 , $435.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pneumococcal Abs,,,,, $362.52 , $362.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pneumonia Vaccine,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pneumothorax Set,,,,," $1,244.44 "," $1,244.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pneumovac 23 Vaccine,,,,, $224.00 , $224.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polycarbophil (Fibercon) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polycitra Lc Sol,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polyethylene Glycol (Miralax),,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polyethylene Glycol 255,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polyethylene Glycol 3350 17 G,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polysomnography W CPAP,,,,," $2,097.74 "," $2,097.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polysomnography W/4+param,,,,," $5,587.26 "," $5,587.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polysomnography W/CPAP,,,,," $6,984.34 "," $6,984.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polyvinyl Alchohol (Liquitear),,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Polyvinyl Alcohol 1 1.4,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pooz Echinococcus,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Porphob Urine (Quant),,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Porphyrin Feces Quant,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Porphyrin Urine Quant,,,,, $457.92 , $457.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Porphyrins Urine 24hr,,,,, $396.44 , $396.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Port Protector,,,,, $227.90 , $227.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Portable O2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Posie Pads,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potass Cl Meq,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potass. Bicarb/Potas. Cit 25mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium 20mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium 24 Hr Urine,,,,, $155.82 , $155.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium 30 ML Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium 99 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Acetate 40meq Vl,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Bicarb 20 Meq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Ch 10meq,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Ch 20 Meq,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 10% 105 ML,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 10% 110 ML Bott,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 10% 120 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 10% 210ml,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 10% 60 ML,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 160 ML,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 20% 60 ML,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 30 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 37.5 ML,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,POTASSIUM CHL 473 ML BOTTLE,,,,," $1,109.00 "," $1,109.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 50 ML,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl 90 ML,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl Sa 10,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chl Sr 20,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chloride (2meq/ML) 4,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chloride (Kcl 20meq),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chloride (K-Dur) 20m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chloride (Klor-Con),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chloride (Micro-K) 8,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chloride 20meq In 10,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Chloride 20meq/15ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,POTASSIUM CHLORIDE ER 8 MEQ,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Citrate (Urocit-K) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium CL 10% 20 MEQ/15ML,,,,, $11.70 , $11.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Cl 10% Liq 105 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Gluc 500 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Gluc 575 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Gluc 595 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Gluconate Tab : 595m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Phos 250,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Phosphate (K Phos) 2,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Phosphate 15mm Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Random Urine,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Serum,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Potassium Urine,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pouch Urostomy W/Karaya 1 3/4,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Povidone Iodine (Betadine) 10%,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Powder, Cellerate 1 Gram",,,,, $118.72 , $118.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Powerpicc Solo 5fr Dual,,,,," $1,866.07 "," $1,866.07 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Powerpicc Solo 5fr Triple,,,,," $2,014.04 "," $2,014.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pra,,,,, $911.00 , $911.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pradaxa 150 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PRADAXA 150MG CAP (Dabigatran),,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pradaxa 75 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramipexole (Mirapex)  0.125mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramipexole (Mirapex) 1mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramipexole .125 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramipexole .25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramipexole .5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramipexole 1 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramoxine 1% (Sarna) Lotion,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramoxine 1% Oint,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pramoxine/Hc (Proctofoam) Foa,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prandin 0.5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prandin 1 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prasugrel HCL 10mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravachol 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravachol 20 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravachol 40 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravachol 80 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravastatin (Pravachol) 10mg T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravastatin (Pravachol) 20mg T,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravastatin 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravastatin 20 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravastatin 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pravastatin Sod 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prazosin 1 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prazosin 2 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prazosin 5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prazosin HCL Cap : 1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pre Albumin,,,,, $110.24 , $110.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Precedex 200 W/Saline 100,,,,, $447.24 , $447.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Precedex 4 MCG/ML Vl 20x50 ML,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Precision Glide 23gx 1 1/4,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Precision Pcx Strip 100 Bx,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Precose 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pred Mild OP Grr 0.12% 5ml,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisolone (Pred Forte) 1% O,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisolone Acetate,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisolone Acetate (Predniso,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisolone Opth 1% 5ml,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisolone Sod (Orapred) Sol,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 15 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 2.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 30 ML,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prednisone 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Preg Test Quan Bhcg,,,,, $122.00 , $122.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pregabalin (Lyrica) 100mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pregabalin (Lyrica) 25mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pregabalin (Lyrica) 50mg Cap,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pregabalin 25mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pregabalin 50 Mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pregabalin 75mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pregnancy Test Urine Qual,,,,, $236.38 , $236.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prelone 5mg/ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Premarin .9 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Premarin 0.3,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Premarin 0.45 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Premarin 0.625 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Premarin 1.25 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Premarin Cream 30g,,,,, $978.00 , $978.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Premarin Vag Cream,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Premoistened Adult Washcloths,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prempro 45/1.5 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prenatal Vitamin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PREPARATION H MAX 0.9 TUBE,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Preparation H Ointment,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PREPARATION H SUPP,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Preparation H Supposority Box,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Preservision Gelcap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Preservision Softgel,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pressure Port for Therapep,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prevacid 15mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prevacid 30mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prevalite Powder,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prevastatin Sod,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prilosec 10 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prilosec Dr 20.6,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prilosec Otc 20 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Primidone (Mysoline),,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Primidone 150mg,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Primidone 25 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Primidone 250 Mg Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Primidone 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PRIMIPEXOLE 0.25 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prinivil 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prisolec Otc,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pristiq 100 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pristiq 50 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pro Air Inh Aerosal,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proair Hfa 90mcg Inh 8.50 Gm,,,,, $200.00 , $200.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proamatine 10 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proamatine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Probenecid (Benemid) 500mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Probenecid Colchicicine,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procainamide,,,,, $74.20 , $74.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procainamide HCL Cr (Procanbid,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procainamide HCL Vl : 100mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procalamine 3% 1000ml Inj,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procardia Xl 30 Mg 1 Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procardia Xl 60 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Processing Autologous,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prochlorperazine (Compazine) 1,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prochlorperazine (Compazine) 2,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prochlorperazine (Compazine) 5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prochlorperazine Supp 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proclactin,,,,, $509.86 , $509.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Procrit 10,000 Units",,,,," $1,002.00 "," $1,002.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Procrit 20,000 U/ML",,,,," $1,815.00 "," $1,815.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procrit 2000 U/ML 6-1ml,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Procrit 3,000 Unites/ML",,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procrit 6 1 ML Vials,,,,," $1,277.00 "," $1,277.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procrit Epoetin Alfa 4000,,,,, $278.00 , $278.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Procrit Inj 10000/1,,,,, $725.00 , $725.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proctosol HCL 2.5% Crm,,,,, $274.00 , $274.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proctozone-Hc 2.5 Cream,,,,, $137.00 , $137.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Progesterone,,,,, $410.22 , $410.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Progesterone Microni (Prometri,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prograf 1 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine (Phenergan) 25mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine 12.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine 25mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine HCL Sup : 50mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine HCL Syr : 6.25mg/,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine HCL Vl : 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine Sup : 12.5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine Supp,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PROMETHAZINE SYR 16 OZ,,,,, $26.16 , $26.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethazine/Cod (Phenergan Vc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promethegan 25 Mg Supp.,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prometrium 100 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promod 30 Cc,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Promod Liquid 32 Oz,,,,, $101.76 , $101.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propafenone (Rythmol) 150mg Ta,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propofol (Diprivan) 10mg/ML 10,,,,, $173.00 , $173.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propofol Vl : 10mg/ML,,,,," $1,389.00 "," $1,389.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propoxyphene (Darvon) 65mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propoxyphene N Apap 100/650,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propoxyphene/Apap (Darvocet N-,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol (Inderal La) 80mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol 20mg,,,,, $4.50 , $4.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol 40 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol 80 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol ER 120 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol HCL (Inderal Sr) C,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol HCL (Inderal) Inj,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol HCL 20mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol HCL Cap : 80mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol HCL ER 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol HCL Sr 120,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propranolol HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Propylthiouracil 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proscar 5 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prosight,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PROSOURCE LIQUID PKT,,,,, $6.92 , $6.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prostat 30 Cc,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prostate Formula,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prostatic Acid Phosphatas,,,,, $225.78 , $225.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prosthetic Training 15min,,,,, $155.00 , $155.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protamine 50mg Amp,,,,, $174.00 , $174.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protectant Skin Lantiseptic,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protector Heel Nonslip Ventila,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein 24hr Urine,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein C Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein Elect Urine 24hr,,,,, $68.90 , $68.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein Electrophore,,,,, $309.00 , $309.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein Phoresis Serum,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein Phoresis Urine,,,,, $345.56 , $345.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein Random Urine,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein S Antigen,,,,, $987.92 , $987.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein S Total,,,,, $855.42 , $855.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein Tot Syn Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein Total,,,,, $30.74 , $30.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protein Total Csf/Fl,,,,, $347.68 , $347.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PROTEINEX 15 ML,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proteinex Liq 30ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protime,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protocream Hc 30gm,,,,, $440.00 , $440.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protonix 20 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protonix 40 Mg Pkts,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protonix 40mg Tab,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Protoporphyrin Rbc (Quant),,,,, $397.50 , $397.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Provera 10 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Provera 5 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Provigil 100 Mg,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Provigil 200 Mg,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Proxy-N/Apap 100,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prozac 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prozac 20 Mg,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prozac 40 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prozac Liquid 20mg/5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prozac Liquid 60 ML Bottle,,,,, $432.00 , $432.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prozac Weekly 90 Mg,,,,, $345.00 , $345.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Prozosin 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PSA Free,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PSA Total,,,,, $399.62 , $399.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pseudfed/Bromphennir (Q-Tapp),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pseudocholinesterase,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pseudoephedrine 30mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pseudoephedrine HCL (Sudogest),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Psittacosis Antibody Panel,,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Psyllium (Metamucil) Packet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Psyllium See Pack,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Adl/15min/-Gp,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Appl Short Arm Splint/Ip,,,,, $312.00 , $312.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Appl Short Leg Splint/Ip,,,,, $316.00 , $316.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Appl Unna Boot/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Apply Unna Boot Bilat/-Gp,,,,, $181.00 , $181.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Evaluation,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Evaluation/-Gp,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Gait Training/15min/-Gp,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Hot/Cold Trmt Pack/-Gp,,,,, $74.00 , $74.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Manual Therapy/15min/-Gp,,,,, $133.00 , $133.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Massage,,,,, $76.00 , $76.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Massage/15min/-Gp,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Muscle Tst Hand W/Rpt/-Gp,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Neuro Re-Ed/15min/-Gp,,,,, $123.00 , $123.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Ortho Fit/Train/15min/-Gp,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Re-Eval,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Re-Evaluation/-Gp,,,,, $154.00 , $154.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Rom Hand/Rep/-Gp,,,,, $70.00 , $70.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Tens Application/-Gp,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Therap Act 1:1/15min/-Gp,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Therapeutic Proc,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Time Sub Plasma Fract,,,,, $86.92 , $86.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT Traction Mechanical/-Gp,,,,, $63.00 , $63.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT/INR,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pta Balloon Brach Ceph Art,,,,," $3,612.48 "," $3,612.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pta Balloon Fem/Pop Artery,,,,," $2,041.56 "," $2,041.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT-E-Stim,,,,, $78.00 , $78.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PTT Practionated,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,PT-Wheelchair Main,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulmicort 0.25/2ml Vial,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulmicort 0.5 Mg,,,,, $126.00 , $126.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulmicort 0.5/2ml Vial,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulmicort Flexhaler,,,,, $656.00 , $656.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulmocare Nutrition,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulse Ox Daily Check,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulse Ox Multiple Determ,,,,," $1,242.32 "," $1,242.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulse Ox Setup,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulse Ox/Multiple,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulse Oximeter,,,,, $268.00 , $268.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulse Oximeter Single Test,,,,, $159.00 , $159.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulse Oximetry Cont Overnight,,,,," $1,745.82 "," $1,745.82 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pulsed Lavage,,,,, $184.44 , $184.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyelogram Retro,,,,," $1,762.00 "," $1,762.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyelogram Retro W/Wo Kub,,,,, $709.00 , $709.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyrazinamide Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyridium 200 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyridium HCL 100mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyridostigmine (Mestinon) 60mg,,,,, $409.00 , $409.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyridostigmine Brom (Mestinon),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyridoxine (Vit B6) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Pyridoxine 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Qnasl Nas Spray,,,,, $700.00 , $700.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Q-Tips,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Qualfenesin Dm 10cc,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quantiferon Tb Gold,,,,, $839.00 , $839.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Questran 2 Gm,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Questran 4 Gram Pkt,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Questran 9gm Scoop,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Questran Pckt 9g,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine (Seroquel) 100mg Ta,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine (Seroquel) 25mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine 100 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine 150 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine 200 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine 25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine 300 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quetiapine 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinapril (Accupril) 20mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinapril (Accupril) 5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinapril 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinapril 20mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinapril 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinapril HCL 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinapril(Accupril)40mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinidex 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinidine 200mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinidine Gluconate C (Quinagl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinidine Gluconate Vl : 80mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinidine Level,,,,, $358.28 , $358.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinidine So4 (Quinidine Su) T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinidine So4 Cr (Quinidex Ext,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinidine Sulfate 300 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinine 325mg Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinine So4 (Quinine Sulf) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,QUININE SULFATE 324MG CAPSULE,,,,, $100.32 , $100.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinine Sulfate 325mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quintine Sulfate 260m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Quinupristin/Dalforp (Synercid,,,,, $751.00 , $751.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Qvar 80 Mcg Inhaler,,,,, $516.00 , $516.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Qvar Inhal,,,,, $825.00 , $825.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ra Titer,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rabies Immune Globul (Bayrab),,,,, $732.00 , $732.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Racepinephrine (S-2) 2.25% Inh,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Radio Ther Hyperthyr Init,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Radiopharmaceutical Thx Oral,,,,," $2,286.42 "," $2,286.42 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Raloxifene (Evista) 60mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ramelteon (Rozerem) Tab : 8mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ramipril (Altace) 1.25mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ramipril (Altace) 2.5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ramipril (Altace) 5mg Cap,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ramipril 10 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ramipril 2.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ramipril 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rampipril 10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranexa 1000 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranexa 500 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranitidine (Zantac) Liq : 75mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranitidine (Zantac) Syr : 15mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranitidine 300 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranitidine 50mg Ivpb (Zantac),,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranitidine 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranitidine Tab : 150mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ranolazine (Ranexa) 500mg Sr T,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rapaflo Cap 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rapamune 1 Mg,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rapid Group A Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rapid Group B Strep,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rasagiline 0.5 Mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Razadyne 12 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Razadyne 16 Mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Razadyne 24 Mg Cap,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Razadyne 8 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Razors,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rbc Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rbc Determ Single Sample,,,,," $1,357.86 "," $1,357.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rbc Sickle Cell Test,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reacher 32,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ready-Bath,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rec Therapy 15 Min,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Recaltrol 0.25 Mcg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Receptal Liner 2000cc,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rectal Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Red Cando Exercise Band 3yrds,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reducing Substance Stool,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reducing Substance Urine,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reemove Aortic Balloon Pmp Sur,,,,, $899.94 , $899.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Refacid Fast Culture,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Refresh Eye Drops,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Refresh Pm Ointment,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Refresh Tears 15ml,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Regranex Gel 0.01%,,,,," $4,243.00 "," $4,243.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Relafen 500 Mg,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reliable Gentle Laxative,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,REMEDY ANTIFUNGAL POWDER 3OZ,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Remeron 15 Mg,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Remeron 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Remeron 45 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Remeron 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Remifemin Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reminyl 12mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Removal of Permanent Pacemaker,,,,," $3,793.74 "," $3,793.74 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renagel 800mg,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renal Angio Bilat,,,,," $3,838.26 "," $3,838.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renal Bilat Arterio S&i,,,,," $3,373.00 "," $3,373.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renal Cap Soft Gel,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renal Catheter Placement,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renal Function Panel,,,,, $563.92 , $563.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renal Sonogram,,,,," $1,749.00 "," $1,749.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renal Uni Arterio S&i,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renin,,,,, $424.00 , $424.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renvela 800 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Renvela Powder Carbonate 2.4g,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Repaglinide (Prandin) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Repaglinide 1 Mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Replc Picc Only Surg,,,,," $2,452.84 "," $2,452.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Repos Prev Cvp W/Fluoro,,,,, $697.48 , $697.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reposition Leads,,,,," $3,916.70 "," $3,916.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reposition of Cvc W/Flouro CPT,,,,, $877.68 , $877.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip .125 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip .25 Mg,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip 0.5mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip 1mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip 2mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip 3mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip 4 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip 8 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Requip Xl 6 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reserpine Tab : 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Resist Exercise Band/Blberry,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Resist Exercise Band/Lime Gr,,,,, $293.62 , $293.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Resource 8 Oz Can,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Resp Ther/Nebulizer Tx,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Resp. Therapist 15 Min=1 Unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Resperdol 1 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Respiratory Therapy Eval 1unit,,,,, $255.00 , $255.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Respironics Filter Bacteria 22,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Restasis 0.05% Eye Emulsion,,,,, $179.00 , $179.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Restasis 0.5%,,,,, $815.00 , $815.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Restoril 15mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Restoril 30 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Restoril 7.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Resuscr Bag/Adult/Mask/Port Lf,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Retic Absolute,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reticulocyte Count,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rexulti 0.5 MG,,,,, $197.00 , $197.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,REXULTI 1 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,REXULTI 2 MG,,,,, $149.00 , $149.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,REXULTI 3 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,REXULTI 4 MG,,,,, $184.68 , $184.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Reyataz 300mg Capsule,,,,," $1,694.00 "," $1,694.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rezadyne 4mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rh Phenotyping,,,,, $161.12 , $161.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rheumatoid Arthritis Panel,,,,, $397.00 , $397.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rhinocort Agua,,,,, $378.00 , $378.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rho(D) Immune Globul (Bayrho),,,,, $575.00 , $575.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rhythmol 150 Mg Propafenone,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ribs 2 Views Uni,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ribs Bilat W/Chest Xray,,,,, $715.50 , $715.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ribs Bilateral,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ribs Bilateral 3v,,,,, $114.48 , $114.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ribs Unilat 2 Views I/F,,,,, $369.00 , $369.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ribs Unilateral,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rickettsial Antibody Igg,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rifampin (Rifadin) 600mg Inj,,,,, $522.00 , $522.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rifampin 150 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rifampin 300mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rifaximin (Xifaxan) 200mg Tab,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risamine Oint,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risedronate (Actonel) 35mg Tab,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risedronate (Actonel) Tab : 5m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risedronate Sodium 30mg,,,,, $257.00 , $257.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risedronate Sodium 35mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal  Lig 30 ML,,,,, $932.00 , $932.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 0.25 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 0.5mg Tab,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 1.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 1mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 1mg/1ml,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 2 Mg,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 4 Mg,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal 6 Mg,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal Consta 12.5 Mg Im,,,,, $766.00 , $766.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal Consta 25mg,,,,, $946.00 , $946.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal Consta 25mg Inj,,,,," $1,716.00 "," $1,716.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal Consta 37.5 Mg Im,,,,," $2,250.00 "," $2,250.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdal Consta 50mg,,,,," $3,147.00 "," $3,147.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperdone 1mg/ML,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperidone .25 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperidone .5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperidone 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperidone 1.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperidone 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperidone 3 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperidone 4 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Risperidone Sol (Risperdal) So,,,,, $775.00 , $775.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ritalan 5 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ritalin 10 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ritalin 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ritalin 5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rituximab (Rituxan) Sdv : 100m,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rivastigmin (Exelon)  9.5mg/24,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rivastigmine (Exelon) 1.5mg Ca,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,RIVASTIGMINE 13.3 MG PATCH,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rivastigmine 3mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,RIVASTIGMINE 4.6 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rivastigmine 6 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,RIVASTIGMINE 9.5 PATCH,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rivastigmine Tart 4.5 Patch,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,RIVASTIGMINE TART CAP 4.5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rizatriptan Benzoate (Maxalt),,,,, $108.00 , $108.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Robaxin 500 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Robaxin 750 Mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Robinul 1 Mg Tab,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Robinul Forte 2 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Robitussin 5ml,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Robitussin Dm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Robitussin Dm 10 ML,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rocaltrol .25mcg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rocaltrol 0.25mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rocephin 1 Gm Vial,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rocephin 2 Gm Im,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rocephin 500mg Vial,,,,, $152.00 , $152.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rocky Mountain Igg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rocky Mtn Spotted Fever,,,,, $508.80 , $508.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rocuronium Br (Zemuron) Mdv :,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ROHTO EYE DROPS,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirol 0.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole (Requip) 0.25mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole (Requip) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole .25mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ROPINIROLE 3 MG,,,,, $3.32 , $3.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole 4 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole HCL,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole HCL 0.25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole HCL 0.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole HCL 1mg (Requip),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ropinirole HCL 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rosiglitazone (Avandia) 4mg Ta,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ROSUVASTATIN 20 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rosuvastatin Calcium (Crestor),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ROSUVASTATIN CALCIUM 10 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ROSUVASTATIN CALCIUM 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ROSUVASTATIN CALCIUM 5 MG,,,,, $2.72 , $2.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rotavirus,,,,, $569.22 , $569.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rozerem 8mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,RPR,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,RPR Titer,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,RSV,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,RSV Rapid Test,,,,, $382.66 , $382.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rt Assessment,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rubella Igg,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rubella Specific Igm,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rubella Titer,,,,, $228.96 , $228.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rubeola Titer,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Russ Viper Venom Time Dil,,,,, $319.06 , $319.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Russel Viper Vernom Time,,,,, $435.66 , $435.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Rythmol 150 Mg Tab,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sacroiliac,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sacroiliac Joints Min 3v,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sacrum,,,,, $311.00 , $311.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,SACRUM FOAM DRESSING EACH,,,,, $16.35 , $16.35 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sacrum/Coccyx 2 Views,,,,, $394.32 , $394.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Salagen 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Salem Sump Tube 18fr,,,,, $596.78 , $596.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Salicylate,,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Saline Flush,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Saline Nasal Spray 1.5 Oz,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Saliva Substitute (Mouthkote),,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Salmeterol/Fluticasone (Advair,,,,, $491.00 , $491.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,SALONPAS LIDOCAINE PATCH,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,SALSALATE 500MG,,,,, $71.22 , $71.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Salsalate Tab : 750mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sal-Tropine (Atropine) Tab : 0,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sam E 200 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sam E 400 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sanctura 20mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sanctura Xl 60 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sanctura Xr 60mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sani Dex Han Sanitizer,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Santyl Top,,,,, $458.00 , $458.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Saphris 10 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Saphris 5 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sarna Lotion,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Savella 50 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sb 12hr Nasal 0.5%,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Scal,stainlesssteel #15dis Ste",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scalpel #10 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scalpel #11 Ss Disp ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scan White Blood Cell,,,,," $3,372.92 "," $3,372.92 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scapula,,,,, $216.00 , $216.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scapula (2 Views),,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scapula Complete,,,,, $386.00 , $386.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scheroderma Antibody,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Schilling Test W&w/O Factor,,,,," $2,176.18 "," $2,176.18 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Schilling Test W/Factor,,,,," $1,191.44 "," $1,191.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Schilling Test W/O Intr Factor,,,,," $1,020.78 "," $1,020.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scoliosis Study Flt&uprt,,,,, $572.00 , $572.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Scopolamine(Transderm Scop) 1.,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seabond Denture Adhesive,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Seal, Eakin Cohesive Large 4",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Secset 34in (Cs/50),,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,SED Rate,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sedimentation Rate -Esr,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sedrate-Westergren,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Selegiline 5mg Cap,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Selegiline 9mg Patch,,,,, $303.00 , $303.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Selegiline HCL Cap : 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Selegiline Transd Patch 20mg,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Selenium (Selsun Blue) Shampoo,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Selenium Shampoo,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Self-Cath Urin Cardinal Health,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sella Turcica,,,,, $331.78 , $331.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Selson Blue Shampoo,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Semen Anal Pres/Motility,,,,, $215.18 , $215.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Semen Analysis Compl,,,,, $98.00 , $98.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Semen Post Vasectomy,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senna (Senokot) 8.6mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senna 8.6mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senna Gen Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senna Plus,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senna Syrup 5 Cc,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senna/Docusate (Senna S) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senna/Docusate Sodium 8.6,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senna/Psyllium (Perdiem) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sennalax-S Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senokot 187mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Senokot 8.6 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sensipar 30 Mg,,,,, $99.00 , $99.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sensitivity Mic,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sensory Integration 15min,,,,, $138.00 , $138.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sensory Test During Endoscopy,,,,, $262.88 , $262.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Septra Ds,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Serax 30 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Serevent Disl Inh,,,,, $548.00 , $548.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroguel 400 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 100 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 12.5 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 200mg Tablet,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 300 Mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 500 Mg,,,,, $124.00 , $124.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 50mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel 75 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel Sr 50 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel Xr 150 Mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel Xr 200 Mg,,,,, $75.00 , $75.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel Xr 300 Mg,,,,, $107.00 , $107.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel Xr 400 Mg,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Seroquel Xr 600 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sertraline (Zoloft) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sertraline 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sertraline 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sertraline HCL 100 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sertraline HCL 25 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sertraline Hyc 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Serzone 100mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Set Catheter Irrigation,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Set Water Pitcher W/Foam Inner,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sevelamer HCL (Renagel) Tab :,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sex Hormone Bind Globulin,,,,," $1,499.90 "," $1,499.90 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sgot or AST,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sgpt or ALT,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shampoo Baby 2 Fl Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shampoo Cap No Rinse W/Cond,,,,, $14.84 , $14.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shampoo Tearless 4 Oz,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shave Cream,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sherrous Sulfate Ltq,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shile Inner Cannula 8.0mm Xlt,,,,, $59.36 , $59.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shiley Inner Cannula Sz 6,,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoe Horn & Ez Dress,,,,, $61.48 , $61.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoe Horn Long 24,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoe Post OP,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoe Protector Non-Skid  Xlarg,,,,," $1,167.06 "," $1,167.06 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shopax 100 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoulder 1 View,,,,, $374.18 , $374.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoulder 3 Views,,,,, $335.00 , $335.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoulder Compl I/F,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoulder Complete Min2v,,,,, $386.90 , $386.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoulder Immobilizer,,,,, $125.08 , $125.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shoulder Limited,,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Shower Caps,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sialography S&i,,,,, $601.02 , $601.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sickle Cell Prep,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sildenafil (Viagra) 25mg Tab,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Silenor 3 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Silvadene Cream,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Silver Nitrate Stick,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Silver Sulfad (Silvadene) 1% C,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Silversulfadiazine,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,SIMBRINZA EYE DROPS,,,,, $631.00 , $631.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simcor 500/20 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simethicone (Mylicon) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simethicone (Mylicon) 80mg/1.2,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simethicone 125 Mg Tabs,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simethicone 80 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simvastatin (Zocor) 20mg Tab,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simvastatin (Zocor) 5mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simvastatin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simvastatin 20 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simvastatin 40 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simvastatin 5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Simvastatin 80 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinemet 10/100 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinemet 12.5/50,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinemet 25/100,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinemet 25/250,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinemet 50/200mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinemet Cr 25/250 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinemet Cr 50/200,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinex Nose Spray,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Singulair 10 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Singulair 5 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinuses <3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinuses 4 Views,,,,, $524.70 , $524.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinuses Complete,,,,, $358.00 , $358.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinuses Limited,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sinuses Waters View,,,,, $413.00 , $413.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sitagliptin (Januvia) 50mg Tab,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skelaxin 800mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skin Biograft,,,,," $1,718.26 "," $1,718.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skin Biograft Add-On,,,,," $1,467.04 "," $1,467.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skin Closure Strips,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skin Prep Pad,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skull 1-3 Views,,,,, $510.92 , $510.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skull Complete,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skull Complete I/F,,,,, $405.00 , $405.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skull Limited,,,,, $261.00 , $261.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Skull Min 4v,,,,, $648.72 , $648.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sling Arm Large,,,,, $28.18 , $28.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sling Full Body 62x45 Solid,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sling Mesh Fullbody 600lb 2xxl,,,,, $42.78 , $42.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slipper Gripper Blue Large 1pr,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slipper Single Tread Beige Xl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slipper Single Trend Xl,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slipper Single Trend Xxl,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slipper Socks,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slo-Niacin 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slow Fe 160mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slow Fe Cr 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slow K-8 Meq,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Slow Mag 64 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sm & Rnp Antibodies,,,,, $463.22 , $463.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sm Adult Blood Pressure Cuff,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Sm Glove,ice,sm",,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Small Bowel Series,,,,," $1,602.72 "," $1,602.72 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Small Bowel/Enterocolysis,,,,," $2,316.10 "," $2,316.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Smart-Site Vital Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Smear Nasal Eos,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Smear Review by Path,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Smear Tzanck Inclus Bod,,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Smz/Tmp Ds 800/160 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Soap Bar,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Soap Deodorant,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Soap, Liquid Dial",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sod Bicarb 2amp/1000ml D5,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sod Biphos/Pot Phosph,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sod Cit/Citric Acid Sol (Bicit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sod Iodine Dx Cap I-131ea Mci,,,,, $418.70 , $418.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Acetate 2meq/ML 20ml Vl,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Bicarb 650mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Bicarb 8.4% (50meq) Syr,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Bicarb Ped Syg : 0.042,,,,, $262.00 , $262.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Bicarbonate 325 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Bicarbonate 50meq Vial,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Bicarbonate 650 Mg Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Bicarnonate 10gr,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Body Fluid,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chl.9% 500gl (Nacl) Sol,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride (Muro 128) Oin,,,,, $87.00 , $87.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride (Nacl) 1gm Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride 0.9% (Ayr) Nas,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride 0.9% 500ml Bag,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride 0.9% for Irr 1,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride 1 Gm Tab,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride 4meq/ML,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride for Inh 0.9% 1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Chloride for Inh 0.9% 3,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Ferric Glucon (Ferrleci,,,,, $225.00 , $225.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Fluoride/Ca (Florical),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Hypochlorite (Dakin's),,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Hypochlorite Sol. 0.25%,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Phos/Sod Biph (Fleets),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Phos/Sod Bipho (Fleet F,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Phosphate 4meq/ML Vl,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Polystyrene (Kayexalate,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Random Urine,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Serum,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium Urine,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium/Misoprostol 75/0.2mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sodium/Potassium/Nac (Eye Wash,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sol Diprivan 1000mg/100mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sol Travasol 8.5% W/Lytes,,,,," $1,455.00 "," $1,455.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sol: Teflaro 600mg/Nacl.9/50ml,,,,, $213.00 , $213.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sol:cefepime HCL .5gm/Nacl0.9%,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sol:midazolam 200mg/Ns100 160m,,,,, $194.00 , $194.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sol:teflaro 400mg/Nacl0.9% 250,,,,, $275.00 , $275.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Solifenacin (Vesicare) 5mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Solo Site Wound Gel (1 Tube),,,,, $77.00 , $77.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Solosite Wound Gel 3oz Tube,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Solu Medrol 125 Mg Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Solu Medrol 40 Mg Vial,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Solu Medrol 80 Mg Im,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Solution Cont Precision Hi/Lo,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Somatomedin Igf1/Arva,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Somatropin (Saizen) Vl : 5mg,,,,," $1,622.00 "," $1,622.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sonata 10mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sonata 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sorbitol 70% 30ml,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sorbitol Sol 60cc Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sotalol 40 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sotalol 80mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sotalol HCL (Betapace Af) Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sotalol HCL 120 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sotalol HCL Tab : 80mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spacer Mdi Aerochamber,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spec Coll 80z Ns W/Gry Lid,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Special Stain Group Ii,,,,, $120.84 , $120.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Special Stains Group I,,,,, $151.58 , $151.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Special Stains Group Ii,,,,, $93.28 , $93.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Specif Grav Urine Auto W/O Mic,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Specific Gravity -Other,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Specific Grav-Urine-Auto W/O M,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Speci-Hat,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Specimen Container (Sterile),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spectazol Cream 1% 30 Gm Tube,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Speech Motion Fluoro by Video,,,,, $618.00 , $618.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Speech Oral-Dysphagia Eval,,,,, $464.00 , $464.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Speech Therapy,,,,, $308.46 , $308.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Speech Therapy Eval,,,,, $484.42 , $484.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Speicmen Collection Commode,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spenco Boot--Inner Cushion,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spenco Boot--Outer,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Cerv 3 Views,,,,, $330.00 , $330.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Cervical 2 or 3 Views,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Cervical 5 Views,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Cervical Compl,,,,, $443.00 , $443.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Cervical Min 4v,,,,, $191.86 , $191.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Comp Ap & Lat,,,,, $849.00 , $849.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Lumb 3 Views,,,,, $640.00 , $640.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Lumb Complete,,,,, $425.00 , $425.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Lumbar Min 4v,,,,, $687.00 , $687.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Single View -Any Lev,,,,, $340.26 , $340.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Thoracic 2 Views,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Thoracic 2v,,,,, $570.28 , $570.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Thoracic 3 Views,,,,, $491.84 , $491.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spine Thoracic W/Swimmers,,,,, $823.62 , $823.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spiriva 18mcg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spiriva 18mcg   30cap,,,,, $484.00 , $484.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spiriva Handihaler,,,,, $429.00 , $429.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spiriva Inhaler,,,,, $444.00 , $444.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spiriva Refill,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spirom Simpl Pft Vc,,,,, $754.72 , $754.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spirometer Incentive Volumetri,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spirono/Hctz 2/25,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spironolactone (Aldactone) 25m,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spironolactone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spironolactone 12.5 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spironolactone 25 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Spironolactone 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Splint Grip W/Terry Cover,,,,, $219.42 , $219.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Splint Wrist Forearm Left,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Splint Wrist Forearm Right,,,,, $28.72 , $28.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Splint, Cock-Up Wrist",,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Split Skin Graft,,,,," $3,782.08 "," $3,782.08 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sporanox 100 Mg,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sporanox 25mg Inj,,,,, $660.00 , $660.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sps Suspension 120 ML Bottle,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sps Suspension 15 ML,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sps Suspension 60ml,,,,, $115.00 , $115.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sputum Collection,,,,, $113.42 , $113.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sputum Induction,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ssd Silver Sulfad Crm : 0.01,,,,, $183.00 , $183.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ssystane Eye Drops,,,,, $104.00 , $104.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ST Dysph/Oral Feed Eval/-Gn,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ST John's Wart,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ST Swallowing Study - Gn,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ST Treatment Post Speech Eval,,,,, $231.08 , $231.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stalevo 100 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stalevo 150 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stalevo 37.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stalevo 50 Mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stalevo 75 Mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Standard Reachers 26 Inches,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Staple Remover Kiet Str Disp,,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Staple Remover Kit,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Starlix 120mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Starlix 60 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Starttera 40 Mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Statlock Catherter Stablizatio,,,,, $42.40 , $42.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Statlock, Picc Securement Devi",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Stckng,antiembolism,thigh,reg",,,,, $69.96 , $69.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stelazine 10 Mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stelazine 5 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stent Placement,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Steri Strips,,,,, $10.50 , $10.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,STERILE CAP MALE,,,,, $0.50 , $0.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Saline 100ml,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Sheets,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Speciman Cups,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Water 1000ml,,,,, $24.38 , $24.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Water 1000ml Inj Bag,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Water 10ml Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Water/Normal Saline,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Water/Normal Salineinj,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Wtr Irrigation 1000cc,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sterile Wtr Irrigation 1000ml,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sternaclavc Jnts,,,,, $218.00 , $218.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sternoclavicular Joints Min 3v,,,,, $393.00 , $393.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sternum,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sternum 1v,,,,, $111.00 , $111.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sternum 2 Views,,,,, $426.12 , $426.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Steth Disposa-A-Scope 30""blu",,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Steth Dispos-A-Scope 30""blue",,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stomahesive Paste 60gm,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stone Analysis,,,,, $349.80 , $349.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stone Analysis Quan,,,,, $326.48 , $326.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stone Rosk Citrate,,,,, $490.78 , $490.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stool for Reducing Substances,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stool Softner,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Straight Catheter,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Strattera 25 Mg,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Strep A Group B Vaginal Swab,,,,, $174.90 , $174.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Strep Group A Antigen,,,,, $206.70 , $206.70 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Streptomycin 1gm Inj,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Stress W/Zinc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Subtraction Study,,,,, $163.24 , $163.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Succinylcholine Cl (Quelicin),,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sucralfate (Carafate) 1000mg S,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sucralfate (Carafate) 1000mg T,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sucralfate 1 Gm,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sucralfate 1 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sucralfate 90 ML Bottle,,,,, $134.00 , $134.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suction,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suction Canister 1200cc,,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suction Canister 2400ml,,,,, $34.98 , $34.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suction Equip Daily,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suction Machine Vacu-Aide Ac O,,,,," $1,417.22 "," $1,417.22 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suction Set Up,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sudafed 12 Hr 10 Mg Tab,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sudafed 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sudafed 30 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sular 17 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sular 34 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sular 8.5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulf/Trimeth 800/160 Vial,,,,, $455.00 , $455.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfa/Pred (Blephamide) Ophth,,,,, $288.00 , $288.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfacetamid (Bleph 10) Oph So,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfameth/Trimethopr Tab : 400,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfameth/Trimethoprim (Bactri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfamethoxazole/Tmp,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfamethoxazole/Trim,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfamethoxazole/Trimeth (Sept,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfamethoxazone/Tri (Sulfatri,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,SULFASALAZINE 500 MG,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulfasalzine Tab : 500mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulindac Tab : 150mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sulindac Tab : 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sumatriptan (Imitrex) 25mg Tab,,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sumatriptan 100mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sumatriptan 25mg,,,,, $427.00 , $427.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sumatriptan Succ,,,,, $101.00 , $101.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sumatriptan Succ (Imitrex) Sdv,,,,, $390.00 , $390.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sumatriptan Succinat (Imitrex),,,,, $114.00 , $114.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sumatriptan Tab 50mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Super Thera Vite Mt,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suplena 120 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Surg Prep Recip Site 1st 100sq,,,,," $1,386.48 "," $1,386.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Surgilube Oin : 60gm,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Surmontil 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Sustane Lubricant Eye Drops,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suture Removal Kit,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Suture Silk Black 2/0 30"" Br",,,,, $328.60 , $328.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suture Strip 1/2x4,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Suture Strip 1/4x3,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Suture, Softsilk Sz 0-30  W/Ne",,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Suture,permahand,blk3/0 30 Sh",,,,, $28.62 , $28.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Svc,,,,," $1,161.76 "," $1,161.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Swab,lemon Glycerin Bx",,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Swallow Clinical Eval,,,,, $854.00 , $854.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Symbicort 160/4.5 Inhaler,,,,," $1,384.00 "," $1,384.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Symbicort 80 4.5,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Symbicort 80/4.5 Mcg Inh,,,,," $1,029.00 "," $1,029.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Symbyax 6/25mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Symmetrel 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Symmetrel 100mg C,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Symmetrel 50 Mg/5ml,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Symmetrel Syr 50mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid .05 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid .2 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 0.05mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 0.075 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 0.125mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 0.150 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 0.175 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 0.1mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 0.25 mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 12.5 Mcg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 200 Mcg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 25 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 37.5 Mcg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 50 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Synthroid 88 Mcg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syrg 20ml Luer-Lok Ster 40box,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 10cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 12cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 1cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 1cc Insulin,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 20cc Ll,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 3cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 3cc Safe Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 3ml Ll W/O Shld Safety,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 5cc,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 5cc Saf Lok,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 60cc/Cath Tip,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 60cc/Luerlock,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe 60ml Luer-Lok Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe Insulin 1ml 29gx 1/2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe Only Safety-Lok 5cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe Safety Lok 3cc,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Syringe W/Needle,safe,1cc 28gx",,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe With Needle,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Syringe, Insulin",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Syringe, Safety-Lok 10cc",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Syringe/Allergy/Insulin/Tb,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Systane 0.3/0.4 %,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Systane Balance Eye Drps,,,,, $65.00 , $65.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Systane Eyedps Single Use Vial,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"System, Vibratory Pep Therapy",,,,, $244.86 , $244.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,T Cell Helper/Suppressor,,,,," $1,043.04 "," $1,043.04 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,T-3 Free,,,,, $966.72 , $966.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,T-3 Resin Uptake,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,T-3 Total,,,,, $379.48 , $379.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tacrolimus,,,,, $65.72 , $65.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tacrolimus (Prograf) 1mg Cap,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tacrolimus (Prograf) 5mg Cap,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tagamet 400 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tamiflu,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tamoxifen (Nolvadex) 10mg Tab,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tamoxifen 10mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tamoxifen 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tamsulosin (Flomax) 0.4mg Cap,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tamsulosin HCL 0.4 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tandem Plus Capsule,,,,, $6.96 , $6.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tanzeum 30 Mg Pen Inject,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tapazole 10 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tapazole 20 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tapazole 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tape Durapore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tape Measure,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tape Micropore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tape Transpore 1,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tape Transpore 2,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tarka 2/240,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tarvatan Drops,,,,, $514.00 , $514.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tavist,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tb Test (Tuberculin)aplisol,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tbc Spray 113.40 ML,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tcp02,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tears Pure,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ted Hose Knee High,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ted Hose Thigh High,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tega Derm Transparent Dressing,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegaderm Dress 4x4.75,,,,, $8.48 , $8.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegaderm Dress 6x8,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegaderm Dressing 2.375x2.75,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegaderm Film 6x8,,,,, $1.06 , $1.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegaderm Sq Sm 5.9x6.0 Abs,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegaderm Trans Dressing 4x5,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegaserod (Zelnorm) 6mg Tab,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegretol 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegretol 200mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegretol 300 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegretol 400 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tegretol Liquid 120 ML Bottle,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tekturna 150 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tekturna 150mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TEKTURNA HCT 300/25 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tekurna 150 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Telfa Dressing,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Telfa Island Dress 4x4 ST,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Telithromycin (Ketek) Tab : 40,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Telmisartan (Micardis) Tab : 4,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Temazepam (Restoril) 15mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Temazepam (Restoril) 7.5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Temazepam 15 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Temazepam 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Temazepam 7.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Temovate 0.5% Cream 45 Gm,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Temovate Oint 0.05% 30gm,,,,, $263.00 , $263.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tempmndublr Jnts,,,,, $269.00 , $269.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tenderwet Abs Gauze 7-3x3,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tenderwet Absorbents Dressing,,,,, $21.20 , $21.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tenecteplase (Tnkase) Kit : 50,,,,," $7,624.00 "," $7,624.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tenex 1 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tenex 2 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tenormin 25mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tenormin 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terazosin,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terazosin (Hytrin) 1mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terazosin (Hytrin) 5mg Cap,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terazosin 1 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terazosin 5mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terazosin HCL 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terazosin HCL 2 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terazosin HCL 5mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terbinafine (Lamisil) 250mg Ta,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terbinafine (Lamisil) Cream,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terbinafine HCL 250,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TERBINAFINE HCL 250 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terbinafine HCL Cr 1%,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terbutaline (Brethine) 1mg/1ml,,,,, $170.00 , $170.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terbutaline Sulfate Tab : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terconazole (Tercon) Crm : 0.0,,,,, $214.00 , $214.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Terconazole Vag (Tercon 7) Crm,,,,, $233.00 , $233.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tessalon Perls 100 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tessalon Prls 200mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Testicular Imaging,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Testicular Scan W/Flow,,,,," $1,714.02 "," $1,714.02 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Testlung Bg 1ltr Heavywall5/Cs,,,,, $186.56 , $186.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Testosterone (Depo Testost) 20,,,,, $344.00 , $344.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Testosterone Free,,,,, $994.28 , $994.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Testosterone Total,,,,, $665.68 , $665.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetanus (Aventis) Vl,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetanus Booster 0.05 Cc Inj,,,,, $162.00 , $162.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetanus Immune Globu (Baytet),,,,, $685.00 , $685.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetanus Toxoid Adsor 5ml,,,,, $418.00 , $418.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetanus/Dipht Pedia Vl,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetanus/Diphth Adult Vl : 5/1.,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetracaine HCL (Pontocaine) Am,,,,, $69.00 , $69.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetracycline 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tetrahydrozoline Eye Drps 50%,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thalidomide (Thalomid) 50mg Ta,,,,, $560.00 , $560.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theo-24 200 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theo-Dur 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theophylline (Elixophyllin) 80,,,,, $496.00 , $496.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theophylline (Theo-Dur) 200mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theophylline 300mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theophylline 400 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theophylline Anhy Sr 200,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theophylline Level,,,,, $321.18 , $321.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thera Tears Nutrition Tabs,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theraband Green,,,,, $431.42 , $431.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theragran M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Therap Group 15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Therapep,,,,, $106.00 , $106.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Therapeutic Grp  15 Min,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Therapeutic M,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Therapuetic Proc 15 Min Exer,,,,, $136.00 , $136.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theraputty Red,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theraputty Yellow,,,,, $16.96 , $16.96 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Therapy Exercises Ea 15 Min,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theraseal Hand Cream,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Theravite Liquid 4oz,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Thermometer, Oral Standard",,,,, $18.02 , $18.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thermotab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Therobec Plus 27/0.8 Mg,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiamin 100 Mg/ML V 2,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiamin 100 Mg/ML V8,,,,, $113.00 , $113.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiamin 50 Mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiamine (Vit B1) 100mg Inj,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiamine (Vit B1) 100mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiamine 100 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiamine 100 Mg/ML Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiamine Vit B1,,,,, $614.80 , $614.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thick & Easy,,,,, $27.56 , $27.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thick It,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thigh Garment Scd,,,,, $75.26 , $75.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thimerosal (Mercuroclear) Sol,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiopental Na Syr (Pentothal),,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thioridazine 50 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thioridazine HCL Tab : 10mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thioridazine HCL Tab : 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,THIOTHIXENE 1 MG,,,,, $5.44 , $5.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiothixene Cap : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thiothixene Cap : 5mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thoracentesis,,,,, $804.54 , $804.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thoracentesis Asp/Pleural CPT,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thorazine 25 Mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thrombectomy Av Fistula Surg,,,,," $2,257.80 "," $2,257.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thrombin 5000 Unit,,,,, $937.00 , $937.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroglobulin Antib,,,,, $752.60 , $752.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroglobulin Antibody,,,,, $519.00 , $519.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid 0.75 Gr,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid 1.5 Grains,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid 2 Gr,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid 30 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid 60 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid Img/Upik Mult Det,,,,," $2,054.28 "," $2,054.28 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid Img/Uptk Mult Det,,,,," $1,675.86 "," $1,675.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid Metastases W/Body,,,,," $2,684.98 "," $2,684.98 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid Scan Imaging Only,,,,," $1,241.26 "," $1,241.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,THYROID TAB .25 GR,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid Tab : 1grain,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroid Uptake Multi Det,,,,," $1,029.26 "," $1,029.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroxine Free T4,,,,, $453.68 , $453.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Thyroxine Total T4,,,,, $46.64 , $46.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tiagabine (Gabitril) 4mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tiagabine 4mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tibc Without Iron,,,,, $260.76 , $260.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tibia & Fibula Min 2v,,,,, $379.00 , $379.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tibia and Fibula,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ticarcillin/Clavulana (Timenti,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ticlid 250 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ticlopidine HCL Tab : 250mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tigan 300 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tigecycline (Tygacil) 50mg Inj,,,,, $377.00 , $377.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tikosyn 250 Mcg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timed Volume Measurement,,,,, $63.60 , $63.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol (Timoptic) 0.5% Eye Dr,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol 0.2% Eye Drops,,,,, $304.00 , $304.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol 0.25% Eye Drps,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol 0.5% Eye Drops,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol 10 Mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol Maleate (Timoptic) Drp,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol Maleate Drp 0.5% 10ml,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol/Dorzolamide (Cosopt) E,,,,, $617.00 , $617.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timolol/Dorzolamide Drp 0.5/2%,,,,, $110.00 , $110.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Timoptic .5% 5ml,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tinactin Powder,,,,, $91.00 , $91.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tinactin Spray,,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tiotropium Bromide (Spiriva) 1,,,,, $287.00 , $287.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tips Ven Portocaval Revise,,,,," $2,378.64 "," $2,378.64 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tips-Ven Anastom Portocaval,,,,," $2,167.70 "," $2,167.70 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tissue Graft Other,,,,," $2,234.48 "," $2,234.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Tissue,facial,stndrd,6x8,72/60",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tivicay 50 mg,,,,, $195.00 , $195.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tizanidine (Zanaflex) 4mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tizanidine 2 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TIZANIDINE 4 MG,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tizanidine HCL 4 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tmj Bi,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tmj Unilat,,,,, $439.90 , $439.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobra/Dexamet (Tobradex) Opth,,,,, $186.00 , $186.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobradex Eye Oint,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobradex OP Grr 5ml,,,,, $221.00 , $221.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobradex Opth Drops,,,,, $196.00 , $196.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin 300mg Inh,,,,, $400.00 , $400.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin 80 Mg Im,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin 80mg Inj,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin 80mg/Nacl .09 100ml,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin So4 (Tobrex) Oin :,,,,, $322.00 , $322.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin Test,,,,, $516.22 , $516.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin/Dexam 5 ML Bottle,,,,, $451.00 , $451.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobramycin/Dexametha (Tobradex,,,,, $419.00 , $419.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tobrex Ointment 3%,,,,, $372.00 , $372.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toes 2 Views,,,,, $248.00 , $248.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tofranil 10mg (Imipramine),,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tofranil 25mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tofranil 50mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tolnafate 1% 28 Gms,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tolnaftate Powder 45 Gm,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tolterodine (Detrol La) 2mg Ca,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tolterodine (Detrol) 2mg Tab,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TOLTERODINE TART ER 4 MG,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TOLTERODINE TARTRATE 1MG TAB,,,,, $5.40 , $5.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tolterodine Tartrate 2mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tongue Blade,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tooth Q Care Suction System,,,,, $41.34 , $41.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toothbrush,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toothette,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toothpaste,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toothpaste Mint 2.7oz,,,,, $3.18 , $3.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topamax 100 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topamax 200 Mg,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topamax 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topical Anesthetic (Topex Spra,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topicort 0.25% Cream,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topiramate  25mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topiramate (Topamax) 100mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topiramate (Topamax) 25mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topiramate 100 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TOPIRAMATE 200 MG,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topiramate 50 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topiramate Quant,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Topotecan HCL (Hycamtin) Sdv :,,,,," $5,408.00 "," $5,408.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toprol 100mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toprol Xl,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toprol Xl 12.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toradol 10 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Torsemide (Demadex) 10mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Torsemide (Demadex) 20mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Torsemide (Demadex) Amp : 10mg,,,,, $267.00 , $267.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Torsemide 10 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Torsemide 20 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Torsemide 40mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Torsemide 5 MG,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TOUJEO INSULIN 1 UNIT,,,,, $1.20 , $1.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toviaz 8 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toviaz ER 4 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toxoplasma Ig6 Ab,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toxoplasma Igm,,,,, $405.98 , $405.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Toxoplasma Igm Ab,,,,, $109.00 , $109.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TPA tissue plasminogen,,,,, $136.12 , $136.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tpn Gravity Bag 3000ml Capacit,,,,, $79.00 , $79.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trac Y Connector,,,,, $12.72 , $12.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trace Elements 5ml,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trach Ballard Kit Et Suct 14fr,,,,, $44.52 , $44.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trach Clean and Care Tray,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Trach Elbow, Double Swivel",,,,, $19.08 , $19.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trach Stay Anti Disconnect Dev,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trach Tube Cuffed Sz4,,,,, $44.37 , $44.37 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trach Tube Cuffed Sz6,,,,, $259.16 , $259.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trach Tube Cuffed Sz8,,,,, $259.10 , $259.10 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trach Tube Cuffless Sz 6,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trach Tube Cuffless Sz 8,,,,, $257.76 , $257.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tracheostomy Planned,,,,," $3,892.32 "," $3,892.32 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tradjenta 5 Mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Training Education 45 or More,,,,, $326.00 , $326.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol (Ultram) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol 25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol 50mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol HCL /Acet,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol HCL 50 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol HCL Tab 50 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol/Acetaminophen (Ultrac,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tramadol/Apap 37.5/325 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trandate 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trandolapril (Mavik) Tab : 2mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trandolapril 4 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transcath Biopsy Superv/Interp,,,,," $1,619.68 "," $1,619.68 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transcath Intro Intravas Stent,,,,," $2,622.44 "," $2,622.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transcath Plmt Intravasc Stent,,,,," $5,613.76 "," $5,613.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transcath Retrieve IV Fb,,,,," $2,174.00 "," $2,174.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transcath Therapy Infus Throm,,,,," $1,170.24 "," $1,170.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transcath Therapy Infusion,,,,, $910.54 , $910.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transcatheter Biopsy Surg,,,,," $1,771.26 "," $1,771.26 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transcatheter Retrieval Df Fb,,,,," $1,092.86 "," $1,092.86 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transderm 1.5 Patch,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transderm Patch 1mg(Scopolamin,,,,, $89.00 , $89.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TRANSDERM SCOP PATCH,,,,, $88.00 , $88.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transferrin,,,,, $290.44 , $290.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Transfuse Blood Products,,,,, $719.74 , $719.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Translum Balloon Angio Ea Add,,,,, $655.08 , $655.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Translum Balloon Iliac Artery,,,,," $3,390.94 "," $3,390.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tranxene 3.75 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tranxene 37.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trap Mucus Specimen 80cc,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trapeze Bar,,,,, $40.00 , $40.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trapeze Free Standing,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Traqzadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trastuzumab (Herceptin) Mdv :,,,,, $177.00 , $177.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Travatan 0.004% Eye Drops,,,,, $323.00 , $323.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Travoprost (Travatan) Opth Sol,,,,, $364.00 , $364.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Travoprost Eye Drops,,,,, $538.00 , $538.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tray Closed Urethral I/O Cath,,,,, $27.80 , $27.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tray Dialysis 12 Fr X 24 Femor,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tray Dialysis 12fr X 16cm Rt I,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tray Dialysis 12fr X 20cm Left,,,,," $1,139.50 "," $1,139.50 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tray Foley Cath 16fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tray Foley Cath 18fr W/Stat Lo,,,,, $248.04 , $248.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tray Urethral No-Cath Pvp,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Tray, Double Letter Black",,,,, $26.50 , $26.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Tray, Percutaneous",,,,, $629.64 , $629.64 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Tray, Wire Black 3  Letter",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Tray,central Line Dressing Ch",,,,, $67.84 , $67.84 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Tray,dressing Chng,chloraprep",,,,, $20.14 , $20.14 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazadone 150 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazadone HCL,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone,,,,, $579.82 , $579.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone (Desyrel) 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TRAZODONE 12.5 mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone 20 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone 200 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone 25 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone 50 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trazodone 75 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Treatment of Swallowing Dysfun,,,,, $400.68 , $400.68 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trental 400mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tresiba (unit),,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TRESIBA 9 ML BOX,,,,," $2,517.00 "," $2,517.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TRIAMCINLIN CREAM 0.5%,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamcinolone (Kenalog) 0.1% C,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamcinolone Ace Crm : 0.005,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamcinolone Acet (Azmacort),,,,, $694.00 , $694.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamcinolone Aceton (Kenalog),,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamcinolone Cr .1 80gm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamcinolone Cr 1%,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamicinolon Oin 1% 15gm Tube,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TRIAMQINOLONE CR 1%,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamter/Hctz 37.5,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamterene Hctz 37.5/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamterene Hctz 75/50,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamterene/Hctz (Maxzide) 37.,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triamterene/Hctz 50/25,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tricor 145mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tricor 48 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tricor 48mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tricyclic,,,,, $195.04 , $195.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trifluoperazine 1 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trifluoperazine 2mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triglycerides,,,,, $132.50 , $132.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trihexiphenidyl (Artane) 2mg T,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trihexyphenidyl 1 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trihexyphenidyl 2 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trihexyphenidyl 5 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trilafon 16mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trilafon 2mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trilafon 4mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trilafon 8 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trileptal 150 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trileptal 300 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trileptal 400 Mg,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trileptal 600 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trileptal 75 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trilipix 135 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trilipix 45 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trimethobenz (Tigan Gen.) Sup,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trimethobenzamide (Tebamide) S,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trimethobenzamide 200mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trimethobenzamide Ea : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trimethobenzamide HCL (Tigan),,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trimethoprim Tab : 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TRIMETHOPRIM/SULF/POLYMXN EYED,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trimethsulfa 160/800,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trimpex 100 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trinexyphenidyl 1 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trinexyphenidyl 2 Mg,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TRINTELLIX 10 MG,,,,, $61.56 , $61.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TRINTELLIX 5 MG,,,,, $63.56 , $63.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triple Antibiiotic Oint 15 Gr,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triple Antibotic (Neosporin) O,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triple Antibotic Oint 1/32 Pkt,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Triple Antibotic Ointment,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tropicamide (Mydrical) Drp : 0,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Troponin Quantitative,,,,, $371.00 , $371.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trospium (Sanctura) 20mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trospium 20 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trusopt 2% 10 ML Bottle,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trypsin/Balsam/Castor (Tbc) Sp,,,,, $95.00 , $95.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Trypsinogen Serum,,,,, $503.50 , $503.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tryptase Serum,,,,, $651.90 , $651.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TSH Thyroid Stim Hormone,,,,, $134.62 , $134.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,T-Tube Chol/Existing Cath CPT,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tub Corrugated Corr-A-Flex 72,,,,, $11.66 , $11.66 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tube Feeding Bag Set,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tube Feeding Spike Set,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tuberculin (Tubersol) 5tu/0.1m,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tubing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tubing 8mm 100ft Roll,,,,, $9.54 , $9.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Tubing Adaptor, Large 22mm X 2",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tubing Circuit/6'f/Cp Ap/Bipap,,,,, $108.12 , $108.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tubing Corrugated,,,,, $33.92 , $33.92 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Tubing, Oxygen No Crush 7""",,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tubng Suctn Connecting 3/16x20,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tubng Suctn Connecting 3/16x6,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tubular Elastic Retention Nett,,,,, $18.82 , $18.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TUDORZA PRESSAIR 400 MCG,,,,, $818.24 , $818.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tularemia Agglutinins,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tumor Local Spect,,,,," $2,794.16 "," $2,794.16 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tumor Local Whole Body,,,,," $2,575.80 "," $2,575.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tums 1000 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tums 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tums 650 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tums 750 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Turmeric Curcumin,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tussin 240 ML Bottle,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tussin 4 Oz Bottle,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tussin Cough 8oz,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tussin Dm 8 Oz,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TUSSIN MUCUS-CONGEST 5 ML,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tussionex 30 Cc Bottle,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tussionex 5 Cc Bottle,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Two Cal Enteral Nutrition,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tygacil 50mg/50 Mls of Ns,,,,, $334.00 , $334.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol 1000 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol 250 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol 325 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol 500 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol 650 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol Ex Str 500 Mg (84 Tabs,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol Pm,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,TYLENOL SINUS SEVERE,,,,, $1.50 , $1.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol Suppository 650mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol W/Codine #3,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Tylenol W/Codine #3 1/2,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Abdomen Complete,,,,," $1,246.56 "," $1,246.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Abdomen Limited,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Aorta,,,,," $1,011.24 "," $1,011.24 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Breast Bilateral,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Breast Uni,,,,, $485.48 , $485.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Carotid Study Compl Bilat,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Carotid Study Lmtd Unil,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Doppler Vendous Extrem Uni,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Doppler Venous Bil,,,,," $1,285.78 "," $1,285.78 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Drain Percut Abcess W/Plmt,,,,," $2,999.80 "," $2,999.80 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Extremity Nonvasc,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Gallbladder,,,,, $675.22 , $675.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Guidance Needle Bx,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Guide Needle Placement,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Guided Paracentesis,,,,," $6,321.84 "," $6,321.84 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Kidney,,,,, $892.52 , $892.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Pelvic Complete,,,,," $1,069.54 "," $1,069.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Pelvic Limited,,,,, $977.32 , $977.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Retro Limited,,,,, $838.46 , $838.46 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Scrotum,,,,, $747.30 , $747.30 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Soft Tiss Head/Neck,,,,, $574.52 , $574.52 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Thyroid,,,,, $711.26 , $711.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Transvaginal,,,,, $749.42 , $749.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Up Ext Art/Graf Bilat Cmp,,,,," $1,892.10 "," $1,892.10 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U/S Upp Ext Arterial Uni/Ltm,,,,," $1,535.94 "," $1,535.94 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,U-Cort Cream 30 Gm,,,,, $156.00 , $156.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uloric 40 Mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,ULORIC 80 MG,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ultracet 100,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ultracet 37.5/325,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ultram 50mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ultrasite Valve-Pos Pres,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ultrasound Extremity,,,,," $1,598.48 "," $1,598.48 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Ultrasound, Abd,b-Scan W/Docu",,,,," $1,867.00 "," $1,867.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Underpad, Drypad Ultrasorb",,,,, $124.02 , $124.02 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Underpads,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uniphyl 400mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uniretic 15 Mg/25 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Univasc 15mg,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Univasc 7.5 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Unna Boot 4""",,,,, $46.00 , $46.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Updraft Set Up,,,,, $97.00 , $97.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Updraft Treatments,,,,, $86.00 , $86.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Upper Gi,,,,, $720.80 , $720.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Upper Gi Series,,,,, $609.00 , $609.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Upper Gi Small Bowel,,,,, $593.00 , $593.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Upper Gi W A/C W Kub,,,,," $1,352.56 "," $1,352.56 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Upper Gi W/Air,,,,, $746.00 , $746.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Upper Gi W/Kub,,,,, $835.00 , $835.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urea Breath Collect,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urea Nitrogen BUN,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urecholine 25mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urecholine 50 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urelle Tablet,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ureter Stent Placement,,,,, $561.80 , $561.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urethrocystogram Vioding S&i,,,,, $637.06 , $637.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uric Acid 24hr Urine,,,,, $246.98 , $246.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uric Acid Fluid,,,,, $145.22 , $145.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uric Acid Serum,,,,, $39.22 , $39.22 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uric Acid Urine,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uricholine 25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urimar-T Tab,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinal,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinal Female Guardian,,,,, $36.04 , $36.04 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinal Male Supreme,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinalysis,,,,, $81.00 , $81.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinalysis Auto W/Micro,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinalysis Chem Only,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinalysis Dipstick,,,,, $62.54 , $62.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinalysis Glucose Quant,,,,, $51.94 , $51.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinalysis Macro Only,,,,, $79.50 , $79.50 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinalysis Micro Only,,,,, $66.78 , $66.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urinary Antiseptic Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urine 24 Hour,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urine Culture,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urine Immun Fixation,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urine Microscopic,,,,, $42.00 , $42.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urobilinogen Qual Urine,,,,, $48.76 , $48.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urobilinogen Urn Qua,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Urogesic Blue Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uroxatral 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Uroxatral 10mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ursodiol (Actigall) 300mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ursodiol (Urso) 250mg Tab,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ursodiol 300 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ursodiol 300mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Us Chest,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Us Guide Pseudo Aneurysm S&i,,,,," $1,048.34 "," $1,048.34 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Us Guide Vascular Access,,,,," $1,134.20 "," $1,134.20 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Us Kidney,,,,, $946.58 , $946.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,UTI STAT LIQUID 30 CC,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,UTI-STAT LIQUID 887 ML BOTTLE,,,,, $201.00 , $201.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vac Ats Canister W/Gel 500ml,,,,, $265.00 , $265.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vac Granufoam Bridge Xg Dress,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vac Granufoam Medium Dressing,,,,, $324.36 , $324.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vac Granufoam Silver Md Dressi,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vac Granufoam Small Dressing,,,,, $257.58 , $257.58 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vac Kit,,,,, $49.82 , $49.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vaccine Rabies (Imovax P/E) Vl,,,,," $1,023.00 "," $1,023.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valacyclovir 1 Gm,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valacyclovir HCL (Valtrex) Tab,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valacyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valcyclovir HCL 500 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valganciclovir (Valcyte) 450mg,,,,, $209.00 , $209.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valisone,,,,, $90.00 , $90.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valium 5 Mg Im,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valium 5 Mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 105 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 110 ML BOTTLE,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid 125mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 140 ML BOTTLE,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 180 ML BOTTLE,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 20 ML BOTTLE,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid 210 ML Bottle,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid 250 Mg Cap,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid 280 ML Bottle,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid 30 ML Bottle,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 350 ML BOTTLE,,,,, $52.76 , $52.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid 40 ML Bottle,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 490 ML BOTTLE,,,,, $66.00 , $66.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid 5 Cc Cup,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid 500mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 60 ML BOTTLE,,,,, $23.20 , $23.20 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALPORIC ACID 70 ML BOTTLE,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valporic Acid Syrp 120ml,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valproate (Depacon) 500mg Inj,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valproic Ac (Dapakene) Tot&or,,,,, $320.12 , $320.12 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valproic Acid (Depakene) 250mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valproic Acid 250mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,valproic acid 250mg/5 ml soln,,,,, $34.17 , $34.17 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valproic Acid Syr : 50mg,,,,, $57.00 , $57.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valprotic Acid 250 Mg,,,,, $129.00 , $129.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valsartan (Diovan) 80mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valsartan 160,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valsartan 320 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VALSARTAN 40 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valsartan 80 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valsartan/Hctz 160/25 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valsartan/HCTZ 320/12.5 MG,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valsartan/Hctz 80/12.5,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valtrex 500 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Valturna 300-320 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vanamide Cream 8.5 Gm,,,,, $299.00 , $299.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin,,,,, $73.00 , $73.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin (Vancocin) 125mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin (Vancocin) 250mg Ca,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin 1.5gm/250ml IV,,,,, $100.00 , $100.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin 1250mg/Nacl 0.9% 25,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin 1500mg/250ml Ns,,,,, $399.00 , $399.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin 1gm Vl,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin 1gm Vl Adv,,,,, $45.00 , $45.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin 500mg Vl,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin HCL 250mg,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin Susp 25mg/ML 4oz,,,,, $105.00 , $105.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vancomycin Test,,,,, $432.48 , $432.48 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vantin 200 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vaprevent Oralcare Kit W/Chg,,,,, $154.76 , $154.76 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Varenicline (Chantix) 1mg Tab,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Varicella,,,,, $147.00 , $147.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Varicella Igg,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Varicella Igm,,,,, $235.32 , $235.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vaseline,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vaseline Gauze 3x9,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vaseline Moist Barrier 2oz,,,,, $13.78 , $13.78 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vaseline Pkts,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vaseretic 10/25 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vasopressin,,,,, $867.08 , $867.08 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vasopressin Vl : 20units,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vasotec 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vasotec 5mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vecuronium 10mg Inj,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vend Adrenal Bi S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vend Extremity Bi S&i,,,,," $1,495.66 "," $1,495.66 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vend Extremity Uni S&i,,,,," $1,827.00 "," $1,827.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vend Renal Bi S&i,,,,," $1,313.00 "," $1,313.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venipuncture,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venlafaxin (Effexor Xr) 37.5mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venlafaxine (Effexor) 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venlafaxine (Effexor) 37.5mg T,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venlafaxine (Effexor) 75mg Cap,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,venlafaxine 25 mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VENLAFAXINE ER 37.5 MG,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VENLAFAXINE HCL 100 MG,,,,, $1.60 , $1.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venlafaxine HCL 37.5 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venlafaxine HCL 75mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venlafaxine HCL ER 150 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venogram Unilateral,,,,," $3,111.00 "," $3,111.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venography Caval Inferio,,,,," $1,009.12 "," $1,009.12 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venous Access Needle/Cath,,,,, $56.18 , $56.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venous Cath Organ Sample Surg,,,,, $743.06 , $743.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venous Doppler of The Legs,,,,," $1,016.00 "," $1,016.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Venous Sampling by Cath S&i,,,,, $644.00 , $644.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventol Ud 0.083%,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventolin 0.5 ML,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventolin 17mg Inh,,,,, $252.00 , $252.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventolin Breathing Treatment,,,,, $294.00 , $294.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventolin HFA 90 Mcg Inhaler,,,,, $13.56 , $13.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventolin Hfa Inh 18 Gm,,,,, $238.00 , $238.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventolin Hfa Inh 8 Gm,,,,, $116.00 , $116.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ventonlin 1gm Inhaler,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Veramyst Nasal Spy 27 Mcg,,,,, $554.00 , $554.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil (Calan) 80mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil 180 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil 20 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil 240 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil 40 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil 60 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil 80 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil HCL Sa 120 Mg,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil HCL Vl : 2.5mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil Sr 240mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil Sr Tab : 180mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Verapamil Tab : 120mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vertebplast Perc Throacic Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vertebplasty Perc Lumbar Init,,,,," $4,037.54 "," $4,037.54 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vesicare 10mg,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vesicare 5mg,,,,, $96.00 , $96.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vest Starter Kit,,,,, $383.72 , $383.72 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Vest, Airway Clearance Large",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Vest, Airway Clearance Medium",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Vest, Airway Clearance Small",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Vest, Airway Clearance Xlrg",,,,, $428.24 , $428.24 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vfend 200mg Tablet,,,,, $764.00 , $764.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Viactiv Chew Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vial Adapter,,,,, $51.00 , $51.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Viamin B Complex Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Viamint E 200iud,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vicodin 5/500 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vicon C,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Victoza Epipen,,,,, $821.00 , $821.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Victoza Pen Bx,,,,," $2,143.00 "," $2,143.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Videx Ec Cap 250mg (Didanosine,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vigamox 0.5% Eye Drops,,,,, $504.00 , $504.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vigamox Drops,,,,, $192.00 , $192.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VIIBRYD 10 MG,,,,, $43.16 , $43.16 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VIIBRYD 20 MG,,,,, $35.00 , $35.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Viibryd 40 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vimpat 100 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VIMPAT 150 MG,,,,, $59.00 , $59.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vimpat 200 Mg,,,,, $52.00 , $52.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vimpat 50 Mg,,,,, $54.00 , $54.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VIMPAT 80 ML BOTTLE,,,,," $1,474.00 "," $1,474.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vinorelbine Tartrate (Navelbin,,,,," $2,499.00 "," $2,499.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Viread 300mg Tablet,,,,, $119.00 , $119.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Viscopaste Pb7,,,,, $109.18 , $109.18 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Viscus Lidocaine Mouthwash,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Visine Eye Drops,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Visken 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vista Pump,,,,, $120.00 , $120.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vista Pump Set,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vistaril 25 Mg Im,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vistaril 25mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vistaril 50 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vistaril 50 Mg Inj,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitabee With C (Multivitamin),,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitalstim Therapy,,,,, $115.54 , $115.54 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin A,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Vitamin A (Aquasol A) 50,000 U",,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Vitamin A 10,000 Units",,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin A 10mu Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin A-Test,,,,, $477.00 , $477.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B 2 100 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B 3 250 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B Complex (Foltx) Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B-1,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B1 100 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B1 50 Mg,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B12,,,,, $425.06 , $425.06 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B-12 1000 Mc,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B12 1000 Mcg Tablet,,,,, $1.00 , $1.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B12 1000 Mcg/ML,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B12 2500 Mcg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B12 50 Mcg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B12 500 Mcg Tab,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B12 Bind Cap,,,,, $242.74 , $242.74 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B12/Falfe 150 Fe Cap,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VITAMIN B12-FOLIC ACID,,,,, $2.80 , $2.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B3 500,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B3 Niacin Sa 750,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B6 100 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B6 300 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B6 50 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin B-6 Pyridoxine,,,,, $925.38 , $925.38 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin C 250 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin C 500 Mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin C Blood,,,,, $625.40 , $625.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D 1 25-Dihydroxy,,,,," $1,055.76 "," $1,055.76 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D 1000 Units-Tablet,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D 25-Oh,,,,," $1,023.96 "," $1,023.96 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D 400 U,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Vitamin D 50,000",,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D 5000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D Level,,,,," $1,085.44 "," $1,085.44 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D3 1000 Units,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D3 2000 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D3 250 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D3 500 Iu,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin D-3 5000mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin E 1000 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin E 400 Unit Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin E 800 Iu,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin E Acetate Cap : 1000iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin E Cap : 200iu,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin E Serum,,,,, $413.40 , $413.40 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin K 10 Mg Inj,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin Multi/Ther/Ca/Fe/1,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitamin Multiple (Gold Age) L,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitiamin D 600 mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vitrase (Hyaluronidase),,,,, $540.00 , $540.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vivactil 10 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vivactil 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vivelle Dot 0.1 Mg Patch,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vivelle Dot Patch 0.375,,,,, $71.00 , $71.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vma Urine,,,,, $157.00 , $157.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vma Urine 24hr,,,,, $487.60 , $487.60 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Volaren 1% Gel,,,,, $222.00 , $222.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Volatiles,,,,, $212.00 , $212.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Voltaren 50 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Voltaren 75mg,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Voltaren Gel 100 Mg Tube,,,,, $242.00 , $242.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Voriconazole (Vfend) 200mg Inj,,,,, $702.00 , $702.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vorl-Csf,,,,, $182.32 , $182.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VRAYLAR 1.5 MG,,,,, $188.88 , $188.88 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VRAYLAR 3 MG,,,,, $167.00 , $167.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VRAYLAR 4.5 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VRAYLAR 6 MG,,,,, $160.00 , $160.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vytorin 10/10 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vytorin 10/20 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Vytorin 10/40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,VYVANSE 50 MG,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wafer,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Waldryl Elixir Each Teaspoon,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin (Coumadin) 1mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin (Coumadin) 2.5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin (Coumadin) 2mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin (Coumadin) 3mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin (Coumadin) 5mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin (Coumadin) 7.5mg Tab,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin 1.25 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin 1.5 Mg,,,,, $2.00 , $2.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin 10 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,WARFARIN 3.75 MG,,,,, $9.28 , $9.28 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin 40mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin 6 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin Sod 1mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin Sod 2.5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin Sod 3 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin Sod 4mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin Sod 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin Sodium 2mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Warfarin Sodium 7.5mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wash Basin,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Washcloth Disp 12-1/4x13,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Water 45 M,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Water 650ml W/O Humidifier Adt,,,,, $25.44 , $25.44 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Water Pitcher,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Water Pitcher 22oz,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Water, 1000ml Inhale Pour",,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Water/Sterile Irrigatn 1000cc,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,WBC,,,,, $62.00 , $62.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,WBC Count Only,,,,, $112.36 , $112.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,WBC W Differential,,,,, $16.00 , $16.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wedgesx2,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Weighted Bendable Fork,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Weighted Bendable Teaspoon,,,,, $60.42 , $60.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Welchol 625 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wellbutrin 300 Mg,,,,, $33.00 , $33.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wellbutrin Hcl75mg(Bupropion),,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wellbutrin Sr 100 Mg,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wellbutrin SR 200mg,,,,, $9.00 , $9.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wellbutrin Xl 150mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,West Nile Igm,,,,, $118.00 , $118.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,West Nile Virus Igm,,,,, $94.34 , $94.34 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,West Prep,,,,, $140.98 , $140.98 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wet Mount,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Whey Protein Isolate,,,,, $131.00 , $131.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wing Infusion 22inch,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Winged Infusion 20in,,,,, $23.32 , $23.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wingset Pbbcs 23x.75 Preattchd,,,,, $15.90 , $15.90 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Witch Hazel (Tucks) Pads,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wnc Diff Only,,,,, $85.86 , $85.86 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Women's One A Day,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wound Care,,,,, $568.00 , $568.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wound Cleaner,,,,, $43.00 , $43.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wound Cleanser Skintegrity,,,,, $31.80 , $31.80 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wound Gel,,,,, $417.00 , $417.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wound Vac,,,,, $128.00 , $128.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wrist 2 Views,,,,, $288.32 , $288.32 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wrist Ap & Lat,,,,, $172.00 , $172.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wrist Complete,,,,, $247.00 , $247.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wrist Min 3 Vws,,,,, $339.00 , $339.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wrist W/Nav 2 Views,,,,, $314.82 , $314.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Wrist With Added Navicular Vie,,,,, $367.82 , $367.82 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xalatan Ophth Solution,,,,, $368.00 , $368.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xanax 0.125 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xanax 0.25 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xanax 0.5 Mg,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xarelto 10 Mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xarelto 15 Mg,,,,, $49.00 , $49.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xarelto 20 Mg,,,,, $50.00 , $50.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xarelto 20 Mg Tablet (Rivaroxa,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xenaderm Oint 60gm,,,,, $286.00 , $286.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xenaderm Ointment 30gm Tube,,,,, $387.00 , $387.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xeroform Petrolatum Dressing,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xifaxan 550 Mg,,,,, $117.00 , $117.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xopenex 0.63 Mg Each Vial,,,,, $25.00 , $25.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xopenex 1.25 Mg/10.5 ML,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xopenex 1.25 Mg/3 ML Vial,,,,, $53.00 , $53.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xopenex 45 Mcg Inhaler,,,,, $276.00 , $276.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xopenex Inh Sol'n 0.63 Mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xopenex Inhaler,,,,, $328.00 , $328.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xray Exam of Eye Socket,,,,, $44.00 , $44.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xray Le Toes Min 2 Views,,,,, $184.00 , $184.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xray Reading Outside,,,,, $128.26 , $128.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xylocaine 1% 20ml,,,,, $67.00 , $67.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xylocaine HCL Mpf (Xylocaine),,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Xyzal 5 Mg Tab,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Yankauer Bulb Tip Sterile,,,,, $6.36 , $6.36 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Yellow Cando Exercise Bnd 3yrd,,,,, $7.42 , $7.42 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Yueh Centesis Disposable Cathe,,,,, $239.56 , $239.56 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Z0cor 20mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zaditor Opt Sol 0.25%,,,,, $68.00 , $68.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zafirlukast (Accolate) 20mg Ta,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zaleplon (Sonata) 5mg Cap,,,,, $20.00 , $20.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zaleplon 10 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zanaflex 4mg,,,,, $31.00 , $31.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zantac 150 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zaroxalyn 5mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zaroxolyn 2.5 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zegerid 40mg Osus Pw,,,,, $34.00 , $34.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zelform 6 Mg,,,,, $37.00 , $37.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zelnorm 2 Mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zemplar .5 Mcg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zemplar 1 Mcg,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zeroform Ptr Dressing,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zestril 10 Mg,,,,, $27.00 , $27.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zestril 20mg,,,,, $32.00 , $32.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zestril 5mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zetia 10 Mg,,,,, $64.00 , $64.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Z-Gen,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ziac 5 Mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zidovudine (Retrovir) Cap : 10,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc 10mg Inj,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc 220mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc 50mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc 50mg Tab,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc Gluconate,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc Oxide (Boudreaux Butt Pas,,,,, $58.00 , $58.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc Oxide Ointment,,,,, $55.00 , $55.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc Oxide Ont,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc Serum,,,,, $316.94 , $316.94 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc Sulfate 220 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zinc Sulfate 220mg Cap,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zioptan Eye Drops,,,,, $528.00 , $528.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ziprasidone (Geodon) 20mg Cap,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ziprasidone (Geodon) 20mg Inj,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ziprasidone 20mg Cap,,,,, $7.00 , $7.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ziprasidone HCL 40 Mg,,,,, $15.00 , $15.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ziprasidone HCL 60 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Ziprasidone HCL 80 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zithromax 250 Mg,,,,, $36.00 , $36.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zithromax 500 Mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zocor 10 Mg,,,,, $26.00 , $26.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zocor 20mg,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zocor 40 Mg,,,,, $13.00 , $13.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zocor 40mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zocor 5mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zocor 80 Mg,,,,, $41.00 , $41.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zofran 2 ML Vial,,,,, $30.00 , $30.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zofran 4mg Tab,,,,, $158.00 , $158.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zofran 4mg/2ml Inj,,,,, $402.00 , $402.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zofran 8 Mg,,,,, $8.00 , $8.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zoledronic Acid (Zometa) Vl :,,,,," $1,332.00 "," $1,332.00 ", $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zolmitriptan (Zomig) Tab : 5mg,,,,, $112.00 , $112.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zoloft 100 Mg,,,,, $28.00 , $28.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zoloft 12.5 Mg,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zoloft 150 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zoloft 200mg,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zoloft 25 Mg,,,,, $23.00 , $23.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zoloft 50mg,,,,, $17.00 , $17.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zoloft 75 Mg,,,,, $24.00 , $24.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zolpidem (Ambien Cr) 12.5mg Ta,,,,, $21.00 , $21.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zolpidem (Ambien) 5mg Tab,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zolpidem 10 Mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zolpidem 2.5 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zolpidem 5 Mg,,,,, $5.00 , $5.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zolpidem Cr 1,,,,, $72.00 , $72.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zolpidem Tartrate,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zonegran 100 Mg,,,,, $14.00 , $14.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zonisamide (Zonegran) Cap : 10,,,,, $12.00 , $12.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zonisamide (Zonegran) Cap : 25,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zonisamide 100mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zonisamide 75mg,,,,, $6.00 , $6.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zostrix Hp Arthritis Crm,,,,, $146.00 , $146.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zosyn 3.375 Gm/Ns 50ml,,,,, $595.00 , $595.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zovirax,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zovirax 15 Mg Cream(Acyclovir),,,,, $982.00 , $982.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zovirax 500mg/Nacl 0.9% 250ml,,,,, $125.00 , $125.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zpak 250 Mg,,,,, $39.00 , $39.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zygomatic Arch,,,,, $393.26 , $393.26 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zygomatic Arch 3 Views,,,,, $505.62 , $505.62 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zylet 5ml Opth Sol,,,,, $264.00 , $264.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyloprim 100mg,,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyloprim 300mg,,,,, $10.00 , $10.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zymar Eye Drops 3% 5 ML Bottle,,,,, $251.00 , $251.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 1.25 Mg,,,,, $3.00 , $3.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 10mg,,,,, $38.00 , $38.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 10mg/ML (Injec),,,,, $163.00 , $163.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 15mg,,,,, $84.00 , $84.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 2.5 Mg,,,,, $48.00 , $48.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 20 Mg,,,,, $94.00 , $94.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 5 Mg,,,,, $19.00 , $19.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 5 Mg Im,,,,, $208.00 , $208.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa 7.5 Mg,,,,, $61.00 , $61.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa Zydis 10 Mg,,,,, $80.00 , $80.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa Zydis 15mg,,,,, $135.00 , $135.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa Zydis 2.5 Mg,,,,, $29.00 , $29.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa Zydis 20 Mg,,,,, $143.00 , $143.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexa Zydis 5mg,,,,, $56.00 , $56.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyprexia 10mg,,,,, $60.00 , $60.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyrtec 10mg,,,,, $22.00 , $22.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyrtec 5mg,,,,, $11.00 , $11.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyrtec D 10 Mg,,,,, $4.00 , $4.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,"Zyrtec D 5/120 ,g",,,,, $18.00 , $18.00 , $-   , $-   ,,,Included in daily Per Diem Rate
Self Pay,Uninsured,DRG,,Zyvox 600 Mg,,,,, $782.00 , $782.00 , $-   , $-   ,,,Included in daily Per Diem Rate
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